子宫颈注射纳米碳示踪子宫恶性肿瘤前哨淋巴结活检学习曲线研究

Learning curve for sentinel lymph node mapping using carbon nanoparticle by cervical injection in early stage uterus cancer

目的探讨早期子宫内膜癌和早期子宫颈癌前哨淋巴结(SLN)活检的学习曲线。方法回顾分析2018年8月至2021年7月吉林省肿瘤医院妇瘤二科经子宫颈注射纳米碳混悬注射液示踪早期子宫颈癌和早期子宫内膜癌前哨淋巴结活检81例患者的临床资料,采用累积和分析法(CUSUM)对早期子宫恶性肿瘤前哨淋巴结显影结局进行分析,以目标成功率85%、90%、92.5%、95%、98%绘制学习曲线图,以曲线最高点对应的手术例数为界,得到技术熟练所需最小手术例数。结果左侧前哨淋巴结活检检出率达96.30%(78/81),右侧前哨淋巴结活检检出率达91.36%(74/81),双侧前哨淋巴结检出率91.36%(74/81)。CUSUM曲线分析显示,初始阶段技术水平波动,后趋于稳定,曲线在手术例数达25例时斜率由正值转为负值,25例为曲线最高点,也就是技术熟练的例数。通过曲线结果分出前24例学习提高阶段及后57例技术熟练阶段,比较两组年龄、BMI、既往是否曾接受子宫颈锥切术、是否有淋巴结转移方面差异无统计学意义,技术熟练阶段显影失败率显著低于学习提高阶段(0 vs.28%,P<0.001)。结论通过CUSUM分析早期子宫恶性肿瘤前哨淋巴结活检达到熟练掌握至少需累积24例子宫颈注射显影剂经验。

Objective To evaluate the learning curve for identification of sentinel lymph nodes(SLN)in patients with early-stage endometrial and cervical cancer.Methods This retrospective analysis included 81 patients with early cervical,or endometrial cancer who underwent SLN mapping using carbon nanoparticle by cervical injection in Department Two of Gynecologic Oncology in Jilin Province Tumor Hospital from Aug.2018 to Jul.2021.Cumulative sum(CUSUM)analysis was performed to assess the learning curves for identification of sentinel lymph nodes at CUSUM target success rates of 85%,90%,92.5%,95%and 98%,the number of cases corresponding to the highest point of the curve was taken as the limit,and the minimum number of surgical cases was counted which were needed to achieve skillful operation.Results SLN mapping was achieved in 96.30%(78/81),91.36%(74/81),and 91.36%(74/81)of the cases involving the right,left,and simultaneous bilateral pelvic areas,respectively.Learning curve analysis based on the cumulative detection rate showed initial fluctuations followed by stabilization,the CUSUM method showed proficient mapping bilateral SLNs after 25 cases.According to the curve results,the first 24 cases of learning improvement stage and the last 57 cases of technical proficiency stage were divided.There were no significant differences in age,BMI,previous cervical conization and lymph node metastasis between the two groups.The failure rate of the skilled stage was significantly lower than that of the improved stage(0%vs.28%,P<0.001)Conclusion Through the analysis of CUSUM,at least 24 cases were required for SLN mapping proficiency in gynecologic cancer.