超声引导下甲状腺结节细针穿刺术的个人学习曲线初步研究

Learning curve of ultrasound-guided fine needle aspiration of thyroid nodules

目的探讨超声引导下无负压甲状腺细针穿刺细胞学(US-FNAC)的学习曲线规律及其影响因素。方法收集分析2017年6月至2018年月6月西安交通大学医学院附属陕西省肿瘤医院由同一医师完成的135例US-FNAC患者的操作耗时及临床病例资料,将患者按手术先后分9组(A^I组),每组15例定为一手术阶段后进行两两对比分析,比较各阶段的操作耗时、并发症及操作无效率。根据得出结果将135例患者分为前、中、后(X、Y、Z)3组,比较组间差异,进一步验证结果。结果在A组至I组进行两两对比统计学分析得出,在A^D组间操作耗时均存在统计学差异(均P<0.05),在D组与E组间出现转折即两组比较差异无统计学意义(P=0.561),而E^I组间差异均无统计学意义(均P>0.05)。X、Y、Z 3组比较中,X组操作耗时明显长于Y组和Z组[分别为(6.23±1.38)min、(3.47±0.45)min、(3.21±0.45)min],X组与Y组和Z组差异均有统计学意义(t=18.07、23.15,均P<0.05),Y、Z两组对比无显著差异(t=1.92,P=0.067)。随着操作例数的增加,并发症及无效操作的发生率逐渐降低。结论对于期望熟练掌握US-FNAC技术的超声医师,遵循对操作的全面认知和科学操作步骤,在指导下开展45例左右的US-FNAC后,可望快速安全越过学习曲线转折点。

Objective To explore the learning curve of ultrasound-guided fine needle aspiration cytology(US-FNAC)without negative pressure and its influencing factors.Methods The operation time and clinical data of 135 patients who underwent US-FNAC by the same doctor at Shaanxi Provincial Tumor Hospital from June 2017 to June 2018 were collected.The patients were divided into nine groups(15 cases in each group)according to date of the operation(groups A-I).The operation time,complications and invalid procedures were compared among each group.According to the results,135 patients were divided into three groups:anterior,middle and posterior(X,Y,and Z),and the differences between each two groups were compared and verified.Results Statistical analysis was conducted in pairs from group A to group I,and it was found that there was statistical difference between groups A-D(P<0.05).There was a turning point between group D and group E,that was,there was no statistical difference between the two groups(P=0.561)as well as between groups E-I(P>0.05).Among groups X,Y,and Z,the operation time of group X was significantly longer than that in group Y and group Z[(6.23±1.38)min,(3.47±0.45)min,and(3.21±0.45)min,respectively;t=18.07,23.15,P=0.000],although there was no significant difference between groups Y and Z(t=1.92,P=0.067).With the increase of operating cases,the incidence of complications and invalid procedures decreased gradually.Conclusion For ultrasonic doctors who perform US-FNAC,following the comprehensive cognition and scientific procedures of operation,45 cases of US-FNAC are expected to pass through the turning point of the learning curve quickly and safely.