胚胎移植操作技能学习曲线分析  

Analysis of learning curve of embryo transfer

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作  者:麦卓瑶 陈晓莉[1] 焦雪丹[1] 黄佳[1] 李予[1] 张清学[1] 潘萍[1] MAI Zhuo-yao;CHEN Xiao-li;JIAO Xue-dan;HUANG Jia;LI Yu;ZHANG Qing-xue;PAN Ping(Department of Reproductive Centre,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区:[1]中山大学孙逸仙纪念医院生殖中心,广东广州510120

出  处:《中国实用妇科与产科杂志》2023年第6期643-646,共4页Chinese Journal of Practical Gynecology and Obstetrics

基  金:广东省自然科学基金(2020A1515011126);中华医学会临床医学科研专项资金(17020480717)。

摘  要:目的探讨临床医生胚胎移植操作技能的学习曲线。方法回顾性分析2017年1月至2019年12月在中山大学孙逸仙纪念医院生殖中心行胚胎移植的患者临床资料,按移植医生年资分为3组:初学者(4位)、低年资(2位)和高年资(4位)。初学者纳入其前200例移植操作,低年资和高年资医生按移植日期连续纳入200例移植操作。结果不同年资医生移植周期的患者年龄、第1周期体外受精(IVF)占比差异均无统计学意义(P>0.05),但新鲜胚胎移植占比、移植胚胎数和人绒毛膜促性腺激素(h CG)日/转化日子宫内膜厚度3组差异有统计学意义(P<0.05)。初学者、低年资和高年资医生每个移植周期临床妊娠率(CPR)分别为46.4%、45.8%和45.4%,差异无统计学意义(P>0.05)。在不同培训阶段对4位初学者进行横向和纵向比较,每个移植周期CPR差异均无统计学意义(P>0.05)。随着胚胎移植操作例数增加,初学者临床妊娠率的四分位间距缩小,在完成50例胚胎移植后,初学者临床妊娠率四分位间距与高年资医生相似。结论在初始学习阶段,初学者胚胎移植存在较明显的学习者个体差异,经过50例移植实践后可达到熟练掌握阶段。建议以50例胚胎移植操作作为胚胎移植技能培训的基本要求。Objective To investigate the learning curve of embryo transfer(ET)in clinicians.Methods A retrospective study was conducted to analyze the clinical data of embryo transfer performed in the Department of Reproductive Centre in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University between January 2017 and December 2019.The data were divided into 3 groups according to the experiences of reproductive endocrinologists.In the group of beginners(n=4),the initial 200 cases of ET were included.In the groups of junior doctors(n=2)and senior doctors(n=4),200 cases of each doctor were included consecutively according to the date of ET.Results Among the doctors with different practice experience,patient's age and proportion of first IVF cycle were similar(P>0.05),but proportion of fresh embryo transfer,number of embryos transferred and endometrial thickness on human chorionic gonadotropin(hCG)day/endometrial transformation day were significantly different in the 3 groups(P<0.05).The clinical pregnancy rates per ET cycle were 46.4%,45.8%and 45.4%respectively in the groups of beginners,junior doctors and senior doctors,with no significant difference(P>0.05).Four beginners were compared at different training stages by both horizontal and vertical comparison,and the clinical pregnancy rates per ET cycle were similar(P≥0.05).Interquartile range of clinical pregnancy rate in beginners narrowed with the increase of ET practice.With the completion of 50 cases,interquartile range of clinical pregnancy rate in beginners was comparable to that in senior doctors.Conclusions In the initial practice stage,there is obvious individual dfference among beginners,and beginners acquire proficiency in the skill after completion of 50 transfers.50 cases are suggested as basic training requirement of ET.

关 键 词:辅助生殖技术 胚胎移植 妊娠率 学习曲线 

分 类 号:R321-33[医药卫生—人体解剖和组织胚胎学]

 

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