神经内镜下经鼻蝶垂体瘤切除术学习曲线的分析及对策

Analysis and Countermeasures of Learning Curve of Neuroendoscopic Transsphenoidal Pituitary Tumor Resection

回顾我院神经内镜下经鼻蝶垂体癌切除术的40个病例,比较分析了初学期和成熟期两组主刀医生的操作成功率、操作时间、出血量、鼻粘膜损伤程度、垂体肿瘤切除程度和死亡率方面的差异。结果发现初学组内镜操作成功率为80%,而成熟组操作成功率为100%,操作失败的原因为蝶窦开口寻找困难和鼻粘膜出血过多;两组在内镜操作时间、出血量、肿瘤切除程度方面有显著差异(P<0.05)。因此,操作医师在进行神经内镜下经鼻蝶垂体瘤切除手术的前5例为学习阶段,需要在经验丰富的上级医师的指导下完成,才能保证手术质量。进行医学模拟技术训练(包括"地图箱"的神经内镜操作训练和尸颅的鼻蝶解剖入路研究)是提高手术成功率的快速、有效的手段。

To study the learning curve of neuroendoscopic transsphenoidal pituitary tumor resection and its countermeasures.Analysising of 40 cases in our hospital who underwent neuroendoscopic transsphenoidal resection of pituitary tumors from the beginning term to maturity term.Compare the differences in successful rate of neuroendoscopic operation,operation time,bleeding volume,the degree of nose mucosal injury,pituitary tumor resection extent and mortality.The neuroendoscopic operation success rate is 80%in the beginner group,yet 100%in the mature group.It is because of the difficulty in looking for sphenoid sinus openings and the nasal bleeding.There are significant differences in operation time,bleeding volume,the degree of nose mucosal injury,pituitary tumor resection extent（P0.05）.It is indispensable to process the first 5 neuroendoscopic transsphenoidal pituitary tumor resection under the guidance of experienced senior neurosurgeons as the learning phase,in order to ensure the high quality of the treatment.Medical simulation trainings（including training of ＂map box＂ neuroendoscopic operation and anatomy research of cadaveric cranial nasal sphenoid） will improve the success rate of the operation efficiently.