经皮肾镜碎石取石术的CUSUM法学习曲线分析

CUSUM analysis of the learning curve of percutaneous nephrolithotomy

目的:探讨经皮肾镜碎石取石术的学习曲线。方法:以累积和分析法(CUSUM)分析2023年6月至2023年11月我院由同一名主刀完成的27例患者的临床资料,患者均行超声引导穿刺的经皮肾镜碎石取石术,对CUSUM学习曲线进行拟合,以R2判断拟合优度。比较学习曲线不同阶段患者的基线资料和围手术期资料的差异,总结从学习阶段进入熟练掌握阶段需要累积的手术例数。结果:所有患者均顺利完成手术,手术时间60~212(128.22±37.19)min,随手术例数的累积呈逐渐下降趋势。学习曲线最佳拟合为三次方曲线,拟合优度系数R2=0.585,拟合方程:CUSUM(27)=-0.008n3-0.049n2+4.231n+57.407(n为手术例数)。拟合曲线在手术例数累积至第11例时达到顶点,以此为分界将学习曲线划分为两个阶段,两个阶段患者留置导尿管时间(P=0.007)和术后住院时间(P=0.022)均存在显著的统计学差异。结论:通过CUSUM分析法对27例经皮肾镜碎石取石术的学习曲线学进行精确分析,表明掌握该技术需累积的手术例数为11例。

Objective:To explore the learning curve of percutaneous nephrolithotomy(PCNL)for stone frag mentation and extraction.Methods:The clinical data of 27 patients who underwent PCNL performed by the same surgeon from June 2023 to November 2023 in our hospital were analyzed using cumulative sum analysis(CUSUM).All patients underwent ultrasound-guided puncture for PCNL.The CUSUM learning curve was fitted and the goodness of fit was assessed using R2.The differences in baseline data and perioperative data at different stages of the learning curve were compared to summarize the number of cases needed to transition from the learning phase to the proficient phase of PCNL.Results:All patients successfully completed the surgery with operation time of(128.22±37.19)minutes(range:60-212 minutes).The cumulative sum showed a decreasing trend with an increas ing number of cases.The best fit for the learning curve was a cubic curve,with a goodness of fit coefficient of R2=0.585.The fitted equation was CUSUM(27)=-0.008n3-0.049n2+4.231n+57.407(where n represents the number of cases).The fitted curve reached its peak at the llth case,dividing the learning curve into two stages.There were significant statistical differences in indwelling catheter time(P=0.007)and postoperative hospital stay(P=0.022)between the patients of two stages.Conclusion:Precise analysis of the learning curve of PCNL for stone fragmentation and extraction in 27 cases using CUSUM analysis indicates that proficiency in this technique requires a cumulative experience of 11 cases.