Learning curve and experience of multi-mode image fusion targeted transperineal biopsy technique using electromagnetic needle tracking under local anaesthesia
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摘要: 目的 探讨电磁针尖引导局部麻醉经会阴前列腺多参数磁共振-经直肠彩超(mpMRI-TRUS)融合靶向穿刺学习曲线及经验。方法 收集2023年1月—2023年7月湖南师范大学附属第一医院(湖南省人民医院)收治的92例行电磁针尖引导局麻经会阴前列腺mpMRI-TRUS融合靶向穿刺活检患者的临床病理资料。采用累积和(cumulative sum，CUSUM)分析法及最佳拟合曲线对该技术的学习曲线进行分析，并比较学习曲线不同阶段患者的临床特点、围手术期资料及穿刺活检的肿瘤阳性率。结果 前列腺活检时间随着穿刺例数的增多，整体呈下降趋势。CUSUM最佳拟合曲线在穿刺第12例时达到峰值，12例为跨越该穿刺技术学习曲线所需要的最少累积手术例数。以此例患者为分界，将前列腺活检学习曲线分为学习提高阶段(A组，12例)及熟练掌握阶段(B组，80例)2个阶段。A组手术时间和穿刺疼痛程度评分均显著高于B组[(23.92±4.01) min vs (16.36±2.37) min，(2.25±0.62)分vs (1.54±0.62)分，P < 0.001)]。A组穿刺满意度评分显著低于B组[(2.25±0.45)分vs (2.75±0.44)分，P < 0.001]。A组与B组在有临床意义前列腺癌(clinically significant prostate cancer，csPCa)检出率[58.33%(7/12) vs 65.00%(52/80)，P=0.749 9]和围术期并发症发生率[41.67%(5/12) vs 18.75%(15/80)，P=0.125 4]方面差异均无统计学意义。结论 电磁针尖引导局麻经会阴前列腺mpMRI-TRUS融合靶向穿刺活检技术分为学习提高阶段和熟练掌握阶段，12例可能是最少累积病例数。Abstract: Objective To explore the learning curve and experience of multiparametric magnetic resonance imaging and transrectal ultrasound image (mpMRI-TRUS) fusion transperineal biopsy technique using electromagnetic needle tracking under local anaesthesia.Methods We retrospectively analysed the clinical and pathological data of 92 patients with mpMRI-TRUS fusion targeted transperineal biopsy using electromagnetic needle tracking under local anaesthesia admitted to the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital) from January 2023 to July 2023. The learning curve of this technique was analyzed by using the cumulative sum(CUSUM) analysis method and the best fitting curve. And the clinical characteristics, perioperative data and tumor positive rate of puncture biopsy of patients at different stages of the learning curve were compared.Results With the increase of the number of surgical cases, the overall operation time showed a downward trend. The best fitting curve of CUSUM reached its peak at the 12th case, which is the minimum cumulative number of surgical cases needed to cross the surgical learning curve. Based on this, the learning curve was divided into two stages: learning improvement stage(Group A, 12 cases) and proficiency stage(Group B, 80 cases). The surgical time and puncture pain score in Group A were significantly higher than those in Group B([23.92±4.01]min vs [16.36±2.37]min, [2.25±0.62]score vs [1.54±0.62]score, P < 0.001). The satisfaction score of puncture in Group A was significantly lower than that in Group B([2.25±0.45]score and [2.75±0.44]score, P < 0.001). There was no statistically significant difference between Group A and Group B in the detection rate of csPCa(58.33%[7/12] and 65.00%[52/80], P=0.749 9) or the incidence rate of complications(41.67%[5/12]and 18.75%[15/80], P=0.125 4).Conclusion The mpMRI-TRUS fusion transperineal biopsy technique using electromagnetic needle tracking under local anaesthesia can be divided into learning improvement stage and proficiency stage, and 12 cases may be the least cumulative number.
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表 1 2个阶段患者一般资料比较
X±S 项目 A组(12例) B组(80例) P值 年龄/岁 68.83±7.70 68.25±7.98 0.8132 前列腺体积/cm3 61.94±30.04 51.37±25.92 0.2003 tPSA/(ng/mL) 25.33±19.10 24.89±22.59 0.9491 PI-RADS评分/分 4.08±1.17 3.78±1.18 0.4000 
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表 2 2个阶段患者的围手术期资料比较
例(%)，X±S 项目 A组(12例) B(80例) P值 OT/min 23.92±4.01 16.36±2.37 < 0.001 VAS-1评分/分 2.25±0.62 1.54±0.62 < 0.001 VNS-1评分/分 2.25±0.45 2.75±0.44 < 0.001 csPCa检出 7(58.33) 52(65.00) 0.7499 手术并发症 5(41.67) 15(18.75) 0.1254 血尿 4(33.33) 13(16.25) 尿潴留 1(8.33) 2(2.5)
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