面肌痉挛微血管减压术的学习曲线

Learning curve of microvascular decompression for hemifacial spasm

目的 探讨面肌痉挛微血管减压 (MVD)手术技术达到熟练的学习曲线规律 ,为更好开展这类手术提供参考。方法 回顾性分析第一作者主刀的我院面肌痉挛微血管减压手术从初期到成熟不同阶段的前 2 0 0例临床资料 ,以每 4 0例作为一个学习曲线阶段 ,比较 5个阶段手术病例在显微操作时间、手术疗效和并发症发生率的差异。结果 5个阶段手术病例在年龄、性别和病程上均无明显差别 (P >0 .0 5 )。早期 80例MVD手术显微镜下操作平均时间为 10 8(10 8± 2 9)min,后期 12 0例镜下操作平均时间缩短为 6 5 (6 5± 2 5 )min,t=11.17,P <0 .0 0 1) ;早期手术并发症发生率为 12 .5 % ,后期下降至 8.3% ;而手术满意疗效则从早期的 75 %大辐上升至后期的 90 % (χ2 =8.0 35 7,P <0 .0 1)。结论 面肌痉挛微血管减压手术的前 80例为学习阶段 ,此阶段内施行手术应在经验丰富的上级医师指导下进行 。

Objective To explore the learning curve of microvascular decompression for hemifacial spasm in order to provide reference to carrying out this kind of delicate operation.Methods Information of 200 hemifacial spasm cases operated by the 1st author from the database was analyzed. These operations covered the stage from beginner's level to matured level. Every 40 cases were taken as a phase of learning curve. The microscopic operation time, surgical outcome and complication rate were compared among the five different phases.Results There was no significant difference among patients in five different phases with respect of age, sex and length of symptom. The mean time of microscopic operation was 108 ( 108±29) min in early 80 cases and declined to a steady state of 65 (65±25 ) min ( P <0.001) in the later 120 cases. Operative complications declined from 12.5% to 8.3% while successful rate jumped from 75% to 90% in the above periods. ConclusionThe first 80 cases of microvascular decompression operation for hemifacial spasm could be regarded as the learning course. The operation during this stage should be guided and assisted by experienced surgeons to assure the treatment of high efficiency and low risk.