颅内大血管急性闭塞中SOLITAIRE支架机械取栓术学习曲线分析  

The learning curve analysis of endovascular thrombectomy with solitaire stent for acute intracranial large-vessel occlusion

作　　者：杨军[1] 宋广福[1] 李洪滨[1] 张世华[1] 杨福义[1] YANG Jun;SONG Guang-fu;LI Hong-bin;ZHANG Shi-hua;YANG Fu-yi(Department of Neurosurgery of the First Affiliated Hospital of Jiamusi University,Jiamusi 154003,China)

机构地区：[1]佳木斯大学附属第一医院神经外科,黑龙江佳木斯154003

出　　处：《黑龙江医药科学》2022年第1期38-41,共4页Heilongjiang Medicine and Pharmacy

基　　金：2021年省卫健委课题,编号:20210404040046。

摘　　要：目的:探讨在急性颅内大血管闭塞中SOLITAIRE支架取栓术的学习曲线。方法:分析2016-04~2019-06佳木斯大学附属第一医院神经外科同一医师急诊手术的50例行SOLITAIRE支架取栓患者的临床资料。按手术时间顺序分为A组(2016-04~2018-01)、B组(2018-02~2019-06),每组25例。选择入院到动脉穿刺时间、动脉穿刺到首次复流时间、入手术室到出手术室时间3项指标描述学习曲线,学习曲线的描绘采用累积和(CUSUM)分析法,同时结合并发症情况对学习曲线进行探讨。结果:50例患者,两组患者的动脉穿刺到首次复流时间有统计学意义(P<0.01),而入院到动脉穿刺时间、入手术室到出手术室时间比较,差异均无统计学意义(均P>0.05)。21例手术后,累计求和分析法学习曲线k值为负。两组患者并发症发生率比较,A组症状性脑出血3例,B组2例,A组死亡4例,B组0例。两组无统计学差异,但A组显示有增高趋势。结论:随着术者经验的积累,SOLITAIRE支架取栓术的安全性不断提高,累积手术例数达到21例时能够较好掌握此项技术,降低并发症发生率。Objective:To explore the learning curve of Solitaire stent thrombectomy in acute Intracranial large-vessel occlusion.Methods:A retrospective analysis of the clinical data of 50 consecutive cases of SOLITAIRE stenting performed by the same surgeon in the department of neurosurgery of the first affiliated Hospital of Jiamusi University from April 2016 to June 2019.According to the operation date,all the patients were divided into A groups(April 2016 to January 2018)and B groups(January 2018 to June 2019),25 cases were included per group.The cumulative sum analysis was used to describe the learning curve at the 3 target times:from admission to arterial puncture,from the arterial puncture to the first re-flow,and from the entry to exit to the operating room.At the same time,we discussed the learning curve in case of complications.Results:In all 50 patients,the time between arterial puncture and first re-flow was statistically significant(P<0.01),but there was no significant difference between admission to arterial puncture and entry to and exit from the operating room(P>0.05).In 21 cases,the cumulative summation analysis showed the k value of the learning curve after surgery was negative.Symptomatic intracerebral hemorrhage as complications was observed in 3 cases in A group and 2 cases in B group.4 cases of death in A group and none in B group.However,A group showed an increasing trend.Conclusions:As the experience of the operator accumulated,the safety of solitaire stenting increased,and when the cumulative number of surgical cases reached 21,the technique can be better mastered and the incidence of complications can be reduced.

关 键 词：颅内大血管急性闭塞 机械取栓术 SOLITAIRE支架 学习曲线 

分 类 号：R651.12[医药卫生—外科学]