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操作频度对超声消融子宫肌瘤学习曲线的影响

ISSN号：1672-8475
期刊名称：《中国介入影像与治疗学》
时间：0
分类：R711.74[医药卫生—妇产科学;医药卫生—临床医学] R737.33[医药卫生—肿瘤;医药卫生—临床医学]
作者机构：[1]重庆医科大学生物医学工程学院、省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室、重庆市生物医学工程学重点实验室,重庆400016, [2]重庆医科大学附属第一医院超声消融治疗中心,重庆400042
相关基金：“十二五”国家科技支撑计划项目（2011BA114801）、973项目（2011CB707900）.

作者：张馨月[1], 陈锦云[1], 胡亮[1], 彭松[2], 陈文直[1], 王智彪[1]

关键词：超声, 高强聚焦, 子宫肿瘤, 学习曲线, 操作频度, Ultrasound, high intensity focused, Uterine neoplasms, Learning curve, Operating frequency

中文摘要：

目的探讨医生操作频度对超声消融子宫肌瘤学习曲线的影响。方法回顾性分析2名已完成超声消融培训的医生（A医生、B医生）分别在各自单位初始独立开展41例（A组）及39例（B组）超声消融治疗的患者资料。采用累积求和法（CUSUM）评估2组的学习曲线。比较2名医生的操作频度是否对学习曲线存在影响。结果A组手术室时间和手术时间明显长于B组（P〈0．05）；两组患者子宫肌瘤消融率差异无统计学意义（P〉0．05），平均每月完成操作A医生为2例、B医生为7例。A医生CUSUM曲线在可接受失败率（H0）和不可接受失败率（H1）之间波动，从23例开始出现下降趋势，但未跨过H0。B医生CUSUM曲线呈现连续下降趋势，在13例时曲线跨过H0。结论操作频度是学习曲线的重要评价指标。超声消融治疗子宫肌瘤有着严格、复杂的程序，连续的操作实践是迅速完成学习曲线的必要前提。

英文摘要：

Objective To investigate the association between operating frequency and the learning curve in treatment of u- terine fibroids with high intensity focused ultrasound （HIFU）. Methods The initial 39 cases （group A） and 40 cases （group B） of ultrasound ablation performed by two surgeon independently in their units were evaluated. Both of the two surgeons had a training in the same teaching hospital. The cumulative summation test （CUSUM） was then used to analyze the learning curve. Operating frequency of two doctors were compared to examine whether there was an association between the frequency and the learning curve. Results The operating room time and operating time in group A were significantly longer than that in group B （P〈0.05）; no significant difference was found in ablation rate among the two groups （P〉 0.05）. CUSUM analysis of doctor A showed that failure rates fluctuated between Ho and H1 , and began to decline from 23 cases but did not across the Ho. Doctor B＇s CUSUM test illustrated that failure rates diminished rapidly and crossed Ho af- ter 13 cases. The mean cases monthly were 2 cases in A doctor and 7 cases in B doctor, respectively. Conclusion Operat- ing frequency is a significant evaluation of learning curve. The treatment of uterine fihroids with HIFU is a demanding, complex procedure, and continuous practices is a necessary prerequisite for the speedy completion of the learning curve.

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