经右颈内静脉可调弯鞘房间隔缺损封堵术的学习曲线分析:单中心经验

Learning curve assessment for Percutaneous trans-jugular vein closure of Atrial septal defect with curve-controllable sheath catheter:A single center experience

目的分析经右颈内静脉可调弯鞘房间隔缺损封堵术的学习曲线。方法2015年1月~2018年6月连续完成的经右颈内静脉可调弯鞘房间隔缺损封堵术病人40例,记录手术时间、穿刺时间、心内操作时间、术中出血量等数据,通过累积求合分析法(cumulative summation,CUSUM),研究该技术的学习曲线。结果40例病人均封堵成功。手术时间、穿刺时间、心内操作时间、术中出血量的平均值分别为(31.2±8.7)分钟、(17.1±4.4)分钟、(14.1±5.3)分钟和(7.6±1.8)ml。CUSUM学习曲线拟合优度R^(2)为0.99,拟合方程为CUSUM=0.001X^(3)-0.123X^(2)+3.264X-2.420(X为手术例数)。拟合曲线在第18例手术时达到最高点,斜率由正转负,18例为跨越学习曲线所需要累积的最低手术例数。结论随着术者经验的积累,经右颈内静脉可调弯鞘房间隔缺损封堵术的安全性不断提高,累积手术例数达到18例时,能够较好掌握此项技术。

Objective To explore the learning curve assessment for percutaneous trans-jugular vein closure of atrial septal defect with curve-controllable sheath catheter.Methods The present analysis included 40 atrial septal defect patients who were consecutively undergone percutaneous trans-jugular vein closure with curve-controllable sheath catheter from a single-center between January 2015 and June 2018.The procedure time,puncture time,intracardiac operation time and intraoperative blood loss were recorded.The learning curve of percutaneous trans-jugular vein closure of atrial septal defect with curve-controllable sheath catheter was analyzed with cumulative summation(CUSUM).Results 40 cases were underwent interventional therapy successfully.The average time of procedure,puncture time,intracardiac operation were(31.2±8.7)min,(17.1±4.4)min and(14.1±5.3)min,respectively;and the average amount of intraoperative blood loss was(7.6±1.8)ml.The fitting equation wasΣi(CUSUM)=0.001 X^(3)-0.123 X^(2)+3.264 X-2.420,and the R^(2)value was 0.99.The curve slope turned into negative at the 18 th case.18 was the minimum number of surgeries that need to be accumulated to cross the learning curve.Conclusion With the increasing of operator’s experience,the safety of percutaneous trans-jugular vein closure of atrial septal defect with curve-controllable sheath catheter was increased.It is suggested from our data that the surgeons need finish about 18 cages to skill this surgery method.