应用刻度肾筋膜扩张器对经皮肾镜碎石学习曲线的影响

摘要

Objective:To explore the effect of renal fascia dilator with scale on learning curve of percutaneous nephroscope lithotripsy (PCNL).Methods: 60 cases of patients with nephrolith underwent PCNL in our hospital from March 2012 to December 2014 were selected, and divided into 6 groups (A, B, C, D, E, F group), according to treatment sequence, with 10 cases in each group. In all patients, renal fascia dilator with scale were used to establish nephroscope channels, the channel setting time and operation time, stone clearance rate, etc. in each group were recorded, and the change on the learning curve were observed.Results: The channel were successfully established in 52 cases, channel was a bit shallow in 8 cases, and established after continued expansion. And there was no bleeding and no peripheral viscera injury. The channel setting time, operation time of group A, B, C were significantly longer than that of group D, E, F, and the differences were statistically significant (F=5.962, 7.013,P<0.05), and channel setting time, operation time between group A, B, C were significantly different (channel setting time:tAB=4.385, tAC=5.018,tBC=4.279,P<0.05; operation time;tAB=5.219,tAC=11.306,tBC=8.253,P<0.05), but there was no significant difference among the group D, E and F (channel setting time:tDE=0.109,tDF=0.011,tEF=0.123,P>0.05; operation time:tDE=0.182,tDF=0.012,tEF=0.297,P>0.05); stone clearance rate of six groups were not significantly different (x2=1.895,P>0.05).Conclusion: In PCNL practice, the work channel is established using renal fascia dilator with scale, the technology of physicians becomes stability after 30-40 cases of surgery, and the learning curve is shorten compared with traditional methods. It is worth popularizing in application.%目的：探讨带刻度肾筋膜扩张器的应用对经皮肾镜碎石学习曲线的影响。方法：选取60例经皮肾镜碎石的肾结石病例，按治疗先后顺序将其分为A组、B组、C组、D组、E组、F组共6组，每组10例。所有患者术中应用带刻度的肾筋膜扩张器建立肾镜工作通道，统计每组通道建立时间、手术时间及结石清除率，观察学习曲线变化情况。结果：在60例肾结石患者中一次性成功建立通道52例，通道建立稍浅8例，通过输尿管镜直视下继续扩张后完成通道建立，未出现大出血及周围脏器损伤。在6组患者中，A组、B组及C组通道建立时间和手术时间均明显长于D组、E组及F组，差异均有统计学意义(F=5.962，F=7.013；P＜0.05)，且A组、B组及C组间通道建立时间相比有差异(tAB=4.385，tAC=5.018，tBC=4.27；P＜0.05)；手术时间相比有差异(tAB=5.219， tAC=11.306，tBC=8.253；P＜0.05)。D组、E组及F组间通道建立时间相比无差异(tDE=0.109， tDF=0.011，tEF=0.123，P＞0.05)；手术时间相比无差异(tDE=0.182，tDF=0.012，tEF=0.297；P＞0.05)。各组间清石率相比无差异(x2=1.895，P＞0.05)。结论：经皮肾镜碎石采用带刻度的肾筋膜扩张器建立肾镜工作通道，在完成约30～40例手术后操作技术开始稳定，与应用传统扩张器相比缩短了学习曲线，有较高的临床及教学价值，值得推广应用。