Stanford B型主动脉夹层腔内修复术学习曲线分析

Endovascular aortic repair for Stanford type B aortic dissection:learning curve analysis

目的探讨介入医师对Stanford B型主动脉夹层患者实施胸主动脉夹层腔内修复术(TEVAR)的学习曲线。方法回顾性分析10年间由同一组介入医师完成的70例B型主动脉夹层TEVAR术,按手术先后次序分为A、B、C、D、E共5组,每组14例。比较各组手术时间、手术相关并发症、术后住院时间,分析不同阶段手术效果。结果 5组患者年龄、性别、分型、伴高血压、伴糖尿病、吸烟史、假腔最大直径、假腔灌注的内脏动脉及其它疾病特征比较,差异均无统计学意义(P>0.05)。手术时间在A、B组分别为(3.29±0.61)h、(2.87±0.37)h(P<0.05),在C、D、E组分别为(1.80±0.62)h、(1.74±0.34)h、(1.52±0.39)h(P>0.05),A、B组手术时间显著长于C、D、E组(P<0.001)。5组患者手术相关并发症发生率差异无统计学意义(P>0.05),住院时间逐渐缩短,但无统计学意义(P>0.05)。A、B组28例手术分别在6.2年、2年内完成,手术频度分别为每年3.3例、7例;B、C、D组42例手术分别在2.2年、1.2年、0.8年内完成,手术频度分别为每年6.4例、11.7例、17.5例。结论 B型主动脉夹层TEVAR术学习曲线约为28例,介入医师在每年平均4.6例手术频度下完成28例手术后手术时间明显缩短,介入医师团队手术技术明显进步。

Objective To analyze the learning curve of an experienced interventional radiologist engaged in thoracic endovascular aortic repair （TEVAR） for Stanford type B aortic dissection. Methods The clinical data of 70 patients with Stanford type B aortic dissection, who received TEVAR that was carried out by the same group of interventional physicians over the past 10 years, were retrospectively analyzed. According to the sequence of operation date, the patients were equally divided into group A, B, C, D and E with 14 patients in each group. The operation time, procedure-related complications, postoperative hospitalization days were compared among the 5 groups, and the curative effects at different stages were evaluated. Results No statistically significant differences in the age, sex, classification, concurrent hypertension, concurrent diabetes, active smoking, maximum diameter of false lumen, viscera artery supplied by the false lumen, etc. existed between each other among the 5 groups （P〉0.05）. The operation time of group A and group B was （3.29±0.61） hours and （2.87±0.37） respectively （P〈0.05）, while the operation time of group C, group D and group E was （1.80±0.62） hours （1.74±0.34） hours and （1.52±0.39） hours respectively （P〉0.05）. The operation time of group A and group B was significantly longer than that of group C, D, and E （P〈0.001）. The difference in the occurrence of complications was not statistically significant between each other among the 5 groups （P〉0.05）. The hospitalization time was gradually shortened from group A to group E, although the difference was not statistically signifieant （P〉0.05）. The surgeries of 28 patients in group A and group B were completed within 2 years and 6.2 years respectively, with an operation frequency being 3.3 patients per year and 7 patients per year respectively ; while the surgeries of 42 patients in group C, group D and group E were completed within 2.2 years, 1.2 years and 0.8 years respectively, with an operation frequency being 6.4 patients per year, 11.7 patients per year and 17.5 patients per year respectively. Conehtsion The learning curve of performing TEVAR for type B aortic dissection is approximately 28 cases; after completing 28 TEVAR procedures for type B aortic dissection at the yearly frequency of 4.6 cases by one interventional radiologist, tbe operation time becomes significantly shortened, and the surgical skills of theinterventional ohvsician team can been significantly imoroved. （J Intervent Radiol, 2017, 26 ： 114-117）