Garg Amit, Yadav Sher S, Tomar Vinay, Priyadarshi Shivam, Giri Vikas, Vyas Nachiket, Agarwal Neeraj
Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Urol Pract. 2016 May;3(3):230-235. doi: 10.1016/j.urpr.2015.06.009. Epub 2016 Feb 17.
We studied the learning curve for percutaneous nephrolithotomy of urology residents according to stone complexity.
The learning curve of 8 residents with no previous experience of solo percutaneous nephrolithotomy was studied. Stones were classified according to complexity using the Guy stone score. Competence was reviewed using 4 markers, namely operative time, fluoroscopic time, complication rate using the modified Clavien grading system and success rate. Analysis was done in 3-month cohorts to determine how and when competence and excellence were achieved during 1 year of training for various grades of stone. The results of resident surgeons were compared with those of experienced endourologist.
Resident surgeons achieved a plateau in mean operative time and fluoroscopic time for grade I stones after 30 to 35 cases but not for more complex stones. Similarly complications were decreased significantly only in grade I stone cases. Resident surgeons also achieved an almost excellent success rate of 87% for grade I stones only.
This study of the learning curve of residents suggests that competence and near excellence is reached after 30 to 35 cases for grade I stones. However the learning curve for complex stones (grades II to IV) is steeper and requires more experience.
我们根据结石复杂性研究了泌尿外科住院医师经皮肾镜取石术的学习曲线。
对8名此前无独立经皮肾镜取石术经验的住院医师的学习曲线进行了研究。使用盖伊结石评分系统根据结石复杂性对结石进行分类。采用手术时间、透视时间、使用改良Clavien分级系统的并发症发生率和成功率这4个指标来评估操作能力。按3个月的队列进行分析，以确定在1年的不同等级结石培训期间如何以及何时实现操作能力和卓越水平。将住院医师外科医生的结果与经验丰富的腔内泌尿外科医生的结果进行比较。
住院医师外科医生在完成30至35例I级结石手术后，平均手术时间和透视时间达到平稳状态，但对于更复杂的结石则未达到。同样，仅在I级结石病例中并发症显著减少。住院医师外科医生仅在I级结石手术中也取得了近87%的优异成功率。
这项关于住院医师学习曲线的研究表明，I级结石在完成30至35例手术后可达到操作能力和接近卓越水平。然而，复杂结石（II至IV级）的学习曲线更陡，需要更多经验。
