直肠超声引导下徒手经会阴前列腺穿刺术的个人学习曲线分析

Analysis of personal learning curve of bare-handed transperineal prostatic puncture guided by transrectal ultrasound

目的分析直肠超声引导下徒手经会阴前列腺穿刺术的个人学习曲线。方法回顾性分析2020年8月至2021年8月在我院由同一医师完成的60例直肠超声引导下经会阴前列腺穿刺术的穿刺时间和临床资料。将60例患者按照穿刺的先后顺序分为(A、B、C)三组,比较各组之间平均穿刺时间、穿刺偏移率以及并发症的差异,并绘制直肠超声引导下经会阴前列腺穿刺时间曲线图。结果A组的平均穿刺时间明显长于B组和C组(28.9±5.9)min vs(15.4±1.6)min和(15.1±0.9)min,差异具有统计学意义(t=9.8、10.3,P均<0.01);B组与C组比较差异无统计学意义(t=0.6,P=0.550)。A、B、C三组的穿刺偏移率分别为20.0%、2.3%、1.8%,A组的穿刺偏移率高于B组和C组,差异具有统计学意义(χ^(2)=80.6、84.7,均P<0.01);B组与C组比较差异无统计学意义(χ^(2)=0.18,P>0.05)。三组的并发症差异无统计学意义(χ^(2)=0.23,P>0.05)。随着操作病例数量的增加,穿刺时间、偏移率及并发症发生率逐渐降低。结论对于期望熟悉掌握直肠超声引导下经会阴前列腺穿刺术的超声科医师,全面学习理论知识和操作步骤,开展约20例穿刺术操作后,学习曲线可快速地通过转折点而进入平台期。

Objective To analyze the personal learning curve of bare-handed transperineal prostate biopsy guided by transrectal ultrasound(TRUS).Methods The clinical data and the time spent for prostate puncture of 60 patients,who received TRUS-guided transperineal prostate biopsy which was accomplished by the same physician at the Affiliated Quanzhou First Hospital of Fujian Medical University of China between August 2020 and August 2021,were retrospectively analyzed.According to the puncture sequence,the 60patients were divided into group A,group B,and group C.The mean time spent for puncturing,the puncturing offset rate,and the incidence of complications were compared between each other among the three groups,and the personal learning time curve of TRUS-guided transperineal prostate biopsy was drawn.Results The mean time spent for puncturing in group A was significantly longer than that in group B as well as than that in group C((28.9±5.9)min vs(15.4±1.6)min vs(15.1±0.9)min),the differences between group A and group B as well as between group A and group C were statistically significant(t=9.8 and t=10.3 respectively,all P<0.01),while the difference in the mean time spent for puncturing between group B and group C was not statistically significant(t=0.6,P=0.550).The puncturing offset rate in group A,group B and group C were 20.0%,2.3%and 1.8%respectively.The puncturing offset rate in group A was higher than that in group B and in group C,the differences between group A and group B as well as between group A and group C were statistically significant(χ^(2)=80.6 andχ^(2)=84.7 respectively,all P<0.01),while the difference in the puncturing offset rate between group B and group C was not statistically significant(χ^(2)=0.18,P>0.05).The difference in the incidence of complications between each other among the three groups was not statistically significant(χ^(2)=0.23,P >0.05).With the increasing of operation numbers,the mean time spent for puncturing,the puncturing offset rate,and the incidence of complications became gradually decreased.Conclusion For ultrasound physicians who expect to master TRUS-guided transperineal prostate biopsy technique,it is necessary to learn comprehensive theoretical knowledge and operational procedures as well as to accomplish about 20 puncturing procedures before their personal learning curves can quickly pass the turning point and reach the plateau period.