区级医院开展经尿道450nm蓝激光前列腺汽化切除术的学习曲线分析

Analysis of the learning curve of transurethral 450 nm blue light vaporization of the prostate in a district hospital

摘要

目的 探讨区级医院开展经尿道450 nm蓝激光前列腺汽化切除术（TUBVP）的学习曲线，为拟开展TUBVP的医师提供参考。方法 回顾性分析2023年6-12月西安市长安区医院泌尿外科接受由同一组医师完成的TUBVP手术治疗的56例良性前列腺增生（BPH）患者的临床资料，采用累积和方法（CUSUM）对前列腺体积/蓝激光出光时间比值（RVOT）的学习曲线进行拟合。根据曲线的拐点数据，将术者的学习曲线分为不同的学习阶段，对不同学习阶段进行手术的患者临床资料进行比较。结果 TUBVP的学习曲线手术例数为21例。术者的学习曲线分为3个阶段：1～21例为学习阶段，22～38例为提高阶段，39～56例为成熟阶段。随着手术例数增加，3个阶段的术后膀胱冲洗时间呈现逐渐下降趋势[40.00（26.00，44.50）h vs. 23.00（20.50，34.00）h vs. 23.50（14.75，40.75）h]，差异有统计学意义（P＜0.05），手术效率呈逐渐上升趋势[（0.51±0.14）vs.（0.55±0.17）vs.（0.63±0.23）]，血红蛋白下降值[（6.43±7.35）g/L vs.（5.65±10.91）g/L vs.（2.61±7.36）g/L]及留置尿管时间[70.0（66.0，106.0）h vs. 71.0（66.0，89.0）h vs. 66.0（58.5，78.5）h]呈逐渐下降趋势，但组间差异均无统计学意义（P＞0.05）。3个阶段患者术后并发症发生率差异无统计学意义（9.5% vs. 5.9% vs. 0，P＞0.05）。结论 TUBVP的学习曲线手术例数为21例，对于区级医院医生而言，TUBVP是一种值得选择的BPH治疗术式。

Abstract

Objective To explore the learning curve of transurethral 450 nm blue light vaporization of the prostate (TUBVP) in a district hospital, in order to provide reference for clinicians who plan to perform TUBVP. Methods The clinical data of 56 patients with benign prostatic hyperplasia (BPH) who received TUBVP performed by the same group of surgeons in Chang'an District Hospital during Jun. and Dec. 2023 were retrospectively analyzed. Cumulative sum (CUSUM) was used to fit the learning curve of ratio of volume to operating time (RVOT) of prostate volume/450 nm blue light. The learning curve was divided into different stages according to the inflection points, and the clinical data of patients operated at different stages were analyzed and compared. Results The learning curve of TUBVP was 21 cases, including 1-21 cases in the learning stage, 22-38 cases in the improvement stage and 39-56 cases in the maturity stage. With the increase of cases, the postoperative bladder irrigation time reduced [40.00 (26.00, 44.50) h vs. 23.00 (20.50, 34.00) h vs. 23.50 (14.75, 40.75) h], with statistical difference (P<0.05). The surgical efficiency increased [(0.51±0.14) vs. (0.55±0.17) vs. (0.63±0.23)], while the reduction of hemoglobin [(6.43±7.35) g/L vs. (5.65±10.91) g/L vs. (2.61±7.36) g/L], catheter indwelling time [70.0 (66.0, 106.0) h vs. 71.0 (66.0, 89.0) h vs. 66.0 (58.5, 78.5) h], and incidence of complications (9.5% vs. 5.9% vs. 0) in the three stages showed a gradually decreasing trend, but with no statistical significance (P>0.05). Conclusion The learning curve of TUBVP is 21 cases. For clinicians in district hospitals, TUBVP is a worthy choice.

关键词

良性前列腺增生 / 450 nm蓝激光 / 经尿道前列腺汽化切除术 / 区级医院 / 学习曲线

Key words

benign prostatic hyperplasia / 450 nm blue laser / transurethral vaporization of the prostate / district hospital / learning curve

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