摘要
目的探讨一次性电子输尿管软镜治疗上尿路结石的学习曲线。方法采用累积和(cumulative sum,CUSUM)控制图的方法对我科同一治疗组2020年3月~2021年3月连续完成的50例一次性电子输尿管软镜钬激光治疗上尿路结石的学习曲线进行分析,对CUSUM曲线进行曲线拟合。结果手术时间随着手术例数的增多,整体呈下降趋势,第6例患者所用手术时间最长,为92 min,第49例患者所用手术最短,为15 min。拟合模型显示经过约24例的临床实践后,手术时间CUSUM穿过0点。以此为分界,将学习曲线分为A、B 2个阶段,将50例分为A、B 2组。A组手术时间(56.7±15.9)min,明显长于B组(34.0±10.9)min(t=5.917,P=0.000)。A组发热率20.8%(5/24),高于B组7.7%(2/26),但差异无显著性(Fisher精确检验,P=0.239)。2组术后带管时间(t=1.830,P=0.073)和住院时间(t=1.348,P=0.184)差异无显著性。结论通过CUSUM分析可以明确分为学习提高、熟练掌握2个不同的阶段,术者跨越其学习曲线达到熟练操作约需积累24例手术。
Objective To investigate the learning curve of disposable flexible ureteroscope for the upper urinary calculi.Methods We recruited and retrospectively analyzed 50 patients with upper urinary calculi treated by disposable flexible ureteroscope combined with holmium laser lithotripsy in our department from march 2020 to march 2021.The cumulative sum(CUSUM)method was adopted and the CUSUM curve was fitted.Results With the increase of the number of surgical cases,the overall operation time showed a downward trend:the 6th patient had the longest operation time(92 min),and the 49th patient had the shortest operation time(15 min).The fitted curve showed that the CUSUM value of the operative time crossed 0 after clinical practice of about 24 cases.According to CUSUM value equal to 0,the learning curve was divided into two stages,stage A and B.Subsequently,the 50 patients were enrolled into group A or group B.The operation time in the group A was significantly longer than that in the group B[(56.7±15.9)min vs.(34.0±10.9)min,t=5.917,P=0.000].The fever rate of the group A was 20.8%(5/24),which was higher than that of the group B 7.7%(2/26),but there was no significant difference(Fisher’s exact test,P=0.239).There was no significant difference in postoperative catheter time(t=1.830,P=0.073)and length of hospital stay(t=1.348,P=0.184)between the two groups.Conclusions According to CUSUM analysis,it can be clearly divided into two different stages:learing improvement and proficiency.For doctors who have mastered disposable flexible ureteroscope and holmium laser lithotripsy,it takes about 24 surgeries to overcome the learning curve to achieve proficiency.
作者
荆强
刘凡
韩帅红
张旭辉
梁学志
曹晓明
Jing Qiang;Liu Fan;Han Shuaihong(Department of Urology, First Hospital of Shanxi Medical University, Taiyuan 030000, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2022年第1期40-44,共5页
Chinese Journal of Minimally Invasive Surgery
基金
山西省重点研发计划项目(201803D121082)。
关键词
输尿管软镜
上尿路结石
学习曲线
Flexible ureteroscope
Upper urinary calculi
Learning curve
