高强度聚焦超声治疗子宫肌瘤初始学习曲线分析

Analysis of the initial learning curve in the treatment of uterine fibroids with high intensity focused ultrasound

目的探讨高强度聚焦超声(HIFU)治疗子宫肌瘤的学习曲线。方法前瞻性研究分析同一组3名接受超声消融培训的医师完成的最初60例HIFU治疗子宫肌瘤手术,按手术日期的先后,将60例患者的临床资料分为A、B和C组,每组20例。分析随手术例数的累积,治疗时间、照射时间、治疗强度、肌瘤消融率和患者不良反应是否存在学习曲线。结果 A组治疗时间明显长于C组(P=0.033);A组照射时间明显长于B、C组(P=0.041、0.038);三组治疗强度、消融率差异无统计学意义(P>0.05)。全部病例无严重并发症发生,不良反应并未随着手术例数的增加有明显改变。治疗时间和照射时间存在学习曲线。结论 HIFU治疗子宫肌瘤存在学习曲线。在40例的操作经验后,治疗时间和照射时间明显缩短,消融率逐渐上升。培训期间,在指导老师监督下的操作是安全的。

Objective To investigate the learning curve of high intensity focused ultrasound（HIFU）in treatment of uterine fibroids.Methods The first 60 consecutive HIFU procedures were performed by a team of 3surgeons.According to the operation date,all patients were divided into three groups：Group A,group B,group C.The learning curve was analyzed through evaluating treatment time,irradiation time,intensity,ablation rate and complications.Results The treatment time in group A was significantly longer than that in group C（P=0.033）;the irradiation time in group A obviously longer than that in group B and C（P=0.041,0.038）;no significant difference was found in intensity and ablation rate among 3groups（P〉0.05）.No serious events occurred.Complications had no obvious changes as the cases increased.Treatment time and irradiation time had learning curve.Conclusion There is a learning curve for the treatment of uterine fibroids with HIFU.After gaining experience in performing 40 cases,the treatment time and irradiation time are significantly reduced,and ablation rate is increased gradually.The operation can be performed safely during the learning period under the supervision.