县级医院开展前列腺钬激光剜除术的学习体会和经验分享

Learning experience of holmium laser enucleation of the prostate in county-level hospitals

目的介绍县级医院泌尿外科循序开展经尿道钬激光前列腺剜除术(HoLEP)治疗良性前列腺增生症(BPH)的学习体会和经验。方法回顾性分析2018年5月—2022年12月在山西省晋城市泽州县人民医院开展HoLEP手术治疗500例BPH患者的学习体会和经验总结。将其分成学习阶段、成熟阶段、熟练阶段三个部分和五个阶段。选取各阶段20例患者,对比其手术时间、术后膀胱冲洗时间和尿失禁患者例数等临床资料。结果全部患者均由同一位泌尿外科医师完成手术。但学习阶段手术时间明显长于其他阶段(P<0.05);学习阶段术后膀胱冲洗时间也显著长于其他阶段(P<0.05);学习阶段术后尿失禁发生例数高于熟练阶段。而熟练阶段无论是手术时间、术后膀胱冲洗时间,还是术后尿失禁发生率都显著优于学习阶段和成熟阶段。结论HoLEP技术需要循序渐进开展,有一定的学习曲线。在县级医院开展需要不断进修学习,提高关键技术的掌握速度。需要高度重视避免术后尿失禁发生的手术操作,掌握其技术要领。

Objective To introduce the learning experience of holmium laser enucleation of prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in county-level hospitals.Methods The clinical data of 500 cases of BPH treated with HoLEP during May 2018 and Dec.2022 were retrospectively analyzed.The learning curve was divided into three stages:learning,maturity and proficiency stages.In each stage,the operation time,postoperative bladder irrigation time and rate of urinary incontinence of 20 patients were analyzed.Results All operations were performed by the same surgeon.During the learning stage,the operation time and bladder irrigation time were significantly longer,and the rate of urinary incontinence was significantly higher.At the proficiency stage,the operation time,bladder irrigation time,and rate of urinary incontinence were significantly improved.Conclusion HoLEP technique needs to be developed step by step with a certain learning curve.Continuous learning and mastery of key technical points are necessary for surgeons in county-level hospitals to avoid postoperative urinary incontinence.