回顾性录像分析法研究经尿道前列腺双极剜除术的手术难点及技巧

The study on operation skills of bipolar transurethral enucleation and resection of the prostate in saline on symptomatic benign prostatic hyperplasia using retrospective video-analysis

目的采用回顾性录像分析法前后对照研究经尿道前列腺双极剜除切除术的手术技巧及解剖标志。方法以我科某泌尿外科医师2010年1月～2011年1月开展的105例经尿道前列腺双极剜除术的手术录像为分析材料,将其每10例为1组,进行自身对照研究,观察不同累积例数和操作水平下的手术情况,比较不同组患者手术时间、出血量、转为普通TURP例数、并发症等指标,总结该手术的难点及技巧。结果前30例组手术患者平均手术时间、出血量、转为普通TURP例数明显多于后30例组,差异有统计学意义(P均<0.01)。结论初学者解剖标志识别能力不足、腔镜操作基本技术不够熟练。随着手术例数增加,其技巧明显得以改善。采用录像分析法自身对照研究不同手术例数阶段的手术实况,可很好显示该手术的难点及技巧,加深初学者对手术解剖层面辨认及技巧的理解。

Objective To investigate the operation skills and anatomic landmark of bipolar transurethral enucleation and resection of the prostate in saline on symptomatic benign prostatic hyperplasia using retrospective video-analysis.Methods The videos of 105 cases of bipolar transurethral enucleation and resection of the prostate in saline,which were performed by a urological surgeon in our department from January 1,2010 to January 1,2011,were retrospectively analyzed.The first 30 cases were compared with the last 30 cases in terms of operative manipulation,outcomes,problems in operation,and complications after operation.The difficulties in learning operation from videos were discussed.Results There were no differences between the six patient groups in age,adenoma size.The operation time,hemoglobulin reduction,frequencies of converting to conventional TURP,and conversion ratio in the first 30 patients were significantly more than those in the last 30 patients（all P〈0.01）.Conclusion The novice had a poor capability of identifying anatomic landmark and enucleation maneuver in manipulating resectoscope sheath and bipolar loop.But along with experience accumulated,the landmark identifying and accomplishments improved.The retrospective video analysis can better display the difficulties in bipolar transurethral enucleation and resection of the prostate in a self control manner,which can help the novice to understand the anatomic landmark and learn the operation skills quickly.The video training method could render assistance to the learning process.