西部地区县级医院大隐静脉曲张微创术式学习曲线的前瞻性随机对照研究  

A prospective randomized controlled study of the learning curve of minimally invasive varicose surgery in county-level hospitals in the western regions of China

作　　者：吴鉴今 郎进军 柏骏 职康康 李军义[3] 刘国军 王东云 田风明 李臣安 樊归仓 李峰 梁继文[2] 曲乐丰 WU Jianjin;LANG Jinjun;BAI Jun;ZHI Kangkang;LI Junyi;LIU Guojun;WANG Dongyun;TIAN Fengming;LI Chen’an;FAN Guicang;LI Feng;LIANG Jiwen;QU Lefeng(Department of Vascular&Endovascular Surgery,Second Affiliated Hospital of Naval Military Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院血管外科,上海200003 [2]西吉县人民医院普通外科 [3]西吉县人民医院医教科

出　　处：《上海医学》2023年第4期208-213,共6页Shanghai Medical Journal

基　　金：上海市优秀学术带头人基金(20XD1404900);海军军医大学第二附属医院创新型临床研究项目(2020YLCYJ-Z09);海军军医大学“三航”军事医学人才项目-启航(2019-Q11-25);海军军医大学第二附属医院金字塔人才工程。

摘　　要：目的比较外科治疗大隐静脉曲张的高位结扎抽剥术(high ligation and stripping,HLS)与腔内射频消融术(radio frequency ablation,RFA)在西部地区县级医院医师培训的效果及其学习曲线。方法选取2018年8月—2020年8月西吉县人民医院普通外科收治的具有外科治疗指征并同意接受治疗的100例单侧大隐静脉曲张患者的资料。采用随机数字表法将患者分为RFA组和HLS组,每组各50例。选择西吉县人民医院普通外科的1名无静脉曲张手术经验、未进行过血管彩色多普勒超声(彩超)操作的主治医师,接受海军军医大学第二附属医院(上海长征医院)血管外科专家组培训,当培训对象在专家组全程帮带下可独立主刀完成HLS和RFA手术各1例时,可参与本研究。将每组50例患者按照时间顺序划分为5个阶段(phase,P):P1(第1~10例)、P2(第11~20例)、P3(第21~30例)、P4(第31~40例)、P5(第41~50例)。P1+P2代表前期,P3代表中期,P4+P5代表后期。选择手术总时间和大隐静脉主干剥离/闭合时间作为主要观察指标。其他指标包括术前培训课时、术中出血量、切口数目、切口总长度(所有切口长度之和)、住院天数、住院费用及术后并发症发生情况。术后3个月门诊随访,观察患者是否存在隐神经损伤、残留曲张静脉,并行下肢血管彩超复查大隐静脉主干是否复通。结果HLS组和RFA组手术总时间和大隐静脉主干剥离/闭合时间的学习曲线均呈现明显下降趋势,RFA组较HLS组的下降程度更为明显。在全期(即P1至P5),HLS组的手术总时间与RFA组的差异无统计学意义(P=0.495),而大隐静脉主干剥离/闭合时间显著长于RFA组(P=0.028)。在前期,RFA组的手术总时间和大隐静脉主干剥离/闭合时间均显著长于HLS组(P值均<0.05);在中期,两组间两个时间的差异均无统计学意义(P值均>0.05);在后期,RFA组的手术总时间和大隐静脉主干剥离/闭合时间均显著短于HLS组(P�Objective To compare the training effect and learning curve of high ligation and stripping(HLS)and radio frequency ablation(RFA)for surgical treatment of great saphenous varicosis in county-level hospitals in western regions of China.Methods From August 2018 to August 2020,100 patients with unilateral varicosis of great saphenous vein were randomly divided into RFA group and HLS group(n=50).A surgeon without experience in varicose vein surgery from the Xiji County People’s Hospital,after receiving training and passing the assessment,performed the surgeries for all patients in the study.The patients in each group were divided into five phases in chronological order:P1(1 st to 10 th cases),P2(11 st to 20 th cases),P3(21 st to 30 th cases),P4(31 st to 40 th cases),and P5(41 st to 50 th cases).P1+P2 was considered as early period,P3 as medium period,and P4+P5 as later period.The total operation time and the great saphenous vein main stripping/closure time were used to evaluate the learning curve.The preoperative training hours,intraoperative blood loss,incision amount,total incision length,hospital stay,hospitalization costs,and postoperative complications were compared between groups.Outpatient follow-up was conducted 3 months after the operation to observe whether there was saphenous nerve injury and residual varicose vein,and vascular ultrasound of lower limbs was performed to check whether the main great saphenous vein was recanalized.Results The total operation time and the great saphenous vein main stripping/closure time showed a significant downward trend on the learning curve in both groups,and the decline in the RFA group was more obvious than that in the HLS group.In the whole period(P1-P5),there was no significant difference in the total operation time between groups(P=0.495),but the saphenous vein main stripping/closure time was significantly shorter in the RFA group than that in the HLS group(P=0.028).In the early period(P1+P2),the total operation time and the great saphenous vein main stripping/closur

关 键 词：西部地区 县级医院 高位结扎抽剥术 腔内射频消融术 学习曲线 

分 类 号：R541[医药卫生—心血管疾病]