经尿道前列腺等离子双极电切术治疗前列腺增生症的学习曲线分析

Learning curve for transurethral plasmakinetic resection of prostate on benign prostate hyperplasia

目的探讨经尿道前列腺等离子双极电切术（PKRP）的学习曲线及治疗前列腺增生症（BPH）的临床效果。方法回顾性分析2012年1月~2013年10月我科室同一个医生连续完成80例PKRP治疗前列腺增生患者的围手术期资料,按其先后顺序分为4组（A、B、C、D组）,每组20例,通过对每组病例相关指标的分析来评估PKRP治疗BPH的学习曲线。结果所有患者手术均获得成功,无中转开放手术;4组患者手术平均时间,A组要明显多于B,C,D组;前列腺切除效率A组明显低于其他各组;随着手术例数增加,术中膀胱造瘘例数呈递减趋势;4组患者术后冲洗液转清时间A组明显要高于其他各组;4组患者术后并发症比较均无明显严重并发症发生;4组患者术后IPSS、QOL、Qmax、PRV四项指标与术前比较差异有统计学意义（P〈0.05）。结论 PKRP治疗前列腺增生安全有效,20例后该技术逐渐进入平台期。

Objective To define a learning curve for transurethral plasmakinetic resection of the prostate（ PKRP） on benign prostate hyperplasia（ BPH）. Methods The clinical data of 80 consecutive patients,who were selected for plasmakinetic resection of prostate form 2012 Jan to2013 Oct by a single surgeon with no experience for this procedure,were retrospectively analyzed. The patients were divided into 4 groups（ A,B,C,D） and n = 20 in each group. According to the relevant indicators in each group,learning curve of PKRP was accessed. Results All the patients underwent PKRP successfully. No operation was converted to open surgery.There were significant differences in the median operation time between group A and group B,C,D（ P 0. 05）. The efficiency of the resection of prostate in group B,C,D was obviously higher than that of group A（ P 0. 05）. With the increase of surgical cases,intraoperative bladder colostomy cases showed a trend of decline. Among the four groups,the postoperative rinses turned clear time of group A was significantly higher than that of other groups（ P 0. 05）. Severe postoperative complications did not happen. After PKRP,the indexs of IPSS,QOL,Qmax,PRV showed significantly improved compared with the preoperative condition（ P 0. 05）. Conclusion PKRP is a safe and effective treatment on BPH. Learning curve of a single surgeon suggests that competence at performing PKRP is reached a plateau after approximately 20 cases.