经会阴径路前列腺穿刺活检技术系统化培训的学习曲线探讨

目的探讨系统化培训泌尿外科住院医师经会阴径路前列腺穿刺活检技术的学习曲线规律。方法按照既定系统化培训流程,对2006年11月至2014年6月期间对11名泌尿外科住院/进修医师进行前列腺穿刺系统化理论培训,在上级医师指导下进行经会阴径路前列腺穿刺活检操作。记录每位学员在学习不同时间段的前列腺穿刺组织长度、操作时间及无效穿刺率等指标,并进行分析。结果所有学员均按照既定培训计划完成该项目培训,平均每人每月完成穿刺操作4~6例次。学习第1个月学员平均取材标本长度和无效穿刺率分别为1.14 cm和74.2%,第2个月为1.24 cm和56.4%。无效穿刺率自第2个月后显著降低,第3个月以后则维持较为稳定的水平。第3~6个月的无效穿刺率和取材组织长度均无统计学差异。穿刺操作时间自第2个月显著减少并维持稳定。结论系统化经会阴径路前列腺穿刺活检包括理论及实际操作学习,是保证高质量前列腺活检的必要途径。在上级医师指导下学员在3个月培训后能够熟悉并掌握经会阴径路前列腺穿刺活检操作。

The learning curve of transperineal biopsy of the prostate for the systematic training program

Objective To investigate the learning curve of transperineal ultrasound -guided prostate biopsy under training programs. Methods A total of 11 urology residents our academic centre completed the 6-month training program following certain training procedure between November 2006 and June 2014. The average length of biopsy cores,negative biopsy rate and biopsy time were recorded and analyzed by regards learning stage. Results All residents finished this training program. The average 4~6 biopsy procedures were performed per month. The average length of biopsy cores and negative biopsy rate were 1. 14 cm and 74. 2﹪ respectively in the first training month comparing 1. 14 cm and 74. 2﹪ in the second month. The negative biopsy rate and the length of biopsy cores were significantly improved from the 2nd month and 3rd month respectively,which remain stable from the 3rd month. The average biopsy time was significantly decreased from the 2nd month. Conclusion Systematic training program is necessary to perform high-quality transperineal TRUS-guided prostate biopsy. In current training program,it is recommended that residents have supervision for at least 3 months training before they are allowed to perform transperineal prostate biopsy with indirect supervision.