直肠超声引导下认知融合磁共振经会阴途径前列腺穿刺活检的个人学习曲线研究

Study on individual learning curve of ultrasound-guided cognitive fusion magnetic resonance transperineal prostate biopsy

目的:探讨直肠超声引导下认知融合磁共振经会阴途径前列腺穿刺活检(CFTPB)的学习曲线规律及其影响因素。方法:收集分析2021年3月—2021年9月同一名泌尿外科医师进行前列腺穿刺理论培训后,在上级医师指导下完成直肠超声引导下CFTPB的临床资料。将接受前列腺穿刺活检的50例患者分为5组,每组10例作为一个阶段进行学习进展情况的对比。比较这名医师对于5组患者进行的前列腺穿刺活检的操作时间、组织取材长度、穿刺有效率、并发症等资料的组间差异,进一步验证结果。结果:学习医生按照既定培训计划完成理论培训后并进行穿刺活检操作。对第1~5组的组间临床数据进行统计分析得出,第1、2、3组的组间比较穿刺操作时间、标本平均长度、有效穿刺率差异有统计学意义(P<0.01),在第3、4、5组的组间的相关数据差异均无统计学意义(P>0.05)。随着学员操作例数的增加,平均操作时间、并发症等逐渐减少并稳定;穿刺标本的平均长度和有效穿刺率逐渐增加并稳定。结论:直肠超声引导下CFTPB的掌握,应该包括理论及实际操作学习2个阶段。在上级医师指导下,学员在经过理论学习和20例左右的穿刺操作后能够越过学习曲线的转折点,掌握这项技术的操作。

Objective: To investigate the learning curve and its influencing factors of ultrasound-guided cognitive fusion magnetic resonance transperineal prostate biopsy(CFTPB). Methods: Analyze the clinical data of the same urologist who completed ultrasound-guided CFTPB under the guidance of superior doctors after prostate biopsy training from March 2021 to September 2021. Fifty patients who underwent prostate biopsy were divided into 5 groups with 10 cases in each group as a stage to compare the learning progress. The operation time, tissue sampling length, puncture efficiency and complications of CFTPB performed by the doctor for 5 groups of patients were compared to further verify the results. Results: After the learner completes the theoretical training according to the training plan, he carries out the operation of CFTPB. Statistical analysis of the data from group 1 to group 5 showed that there were significant differences in operation time, average length of specimens and effective puncture rate among groups 1, 2 and 3(P<0.01), and there was no significant difference in the relevant data among groups 3, 4 and 5(P>0.05). With the increase of the number of CFTPB operated by the doctor, the average operation time and complications gradually decreased and stabilized;The average length and effective puncture rate gradually increased and stabilized. Conclusion: The mastery of ultrasound-guided CFTPB should include two stages: theoretical and practical learning. Under the guidance of tutor doctors, the learner can stride across the turning point of the learning curve and master the operation after theoretical learning and about 20 operations.