70例腔镜大隐静脉获取术的手术者学习曲线分析  

Learning curve of 70 cases of endoscopic saphenous vein harvesting

作　　者：徐灿[1] 王阔 徐贞俊[1] 范阜东[1] 潘俊[1] 周庆[1] 王东进[1] Xu Can;Wang Kuo;Xu Zhenjun;Fan Fudong;Pan Jun;Zhou Qing;Wang Dongjin(Department of Thoracic and Cardiovascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《中华解剖与临床杂志》2023年第9期593-597,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81970401);南京鼓楼医院新技术发展基金(XJSFZJJ201930)。

摘　　要：目的探讨在冠状动脉旁路移植术(CABG)中应用腔镜获取大隐静脉技术获得桥血管的学习曲线特征。方法横断面研究。纳入2019年7月—2020年7月南京大学医学院附属鼓楼医院心胸外科冠脉组70例接受CABG的冠心病患者,其中男55例、女15例,年龄49~82岁。70例患者CABG术中腔镜获取大隐静脉的操作均由同一名医生完成。按照患者接受手术的先后次序,将患者每10名分为一组,共分7组,依次为S1~S7组;观察并比较7组患者基线资料,以及获取大隐静脉长度(L)、获取大隐静脉时间(T)、大隐静脉损伤数量和L/T比值。应用Pearson相关分析找出学习曲线拐点,根据学习曲线拐点将70例患者分为拐点前组与拐点后组,比较2组患者基线资料以及上述各指标。结果S1组~S7组患者性别、年龄、合并糖尿病和高血压病等基线资料组间比较,差异均无统计学意义(P值均>0.05)。各组获取大隐静脉时间、大隐静脉损伤数量以及L/T比值比较,差异均有统计学意义(F=4.95、3.85、5.12,P值均<0.001),其中S7组获取大隐静脉时间最短、大隐静脉损伤数量最少、L/T比值最高,S1组获取大隐静脉时间最长、大隐静脉损伤数量最多、L/T比值最低;7组获取大隐静脉长度比较,差异无统计学意义(F=0.69,P=0.056)。Pearson相关分析结果显示:(1)L/T比值与手术例次(即腔镜获取大隐静脉数量)间呈正相关(r=0.79,P<0.001);(2)L/T比值在前35例随着术者手术例次的增多而快速增长,其后则增速放缓、进入平台期,因此,将第35例确定为腔镜获取大隐静脉手术的学习曲线拐点,并据此将全组70例分为拐点前、后两组,每组35例。与拐点前组相比,拐点后组腔镜获取大隐静脉时间缩短、大隐静脉损伤数量减少、L/T比值增加,差异均有统计学差异(t=6.32、8.08、6.71,P值均<0.001);2组腔镜获取大隐静脉长度比较差异无统计学意义(P=0.167)。结论通过足够的培训时间和恰当Objective This study aimed to explore the characteristics of the learning curve of laparoscopic harvesting of the great saphenous vein in coronary artery bypass grafting(CABG).MethodA cross-sectional study was conducted.This study included a total of 70 patients with coronary artery disease who underwent CABG in the coronary group of the Department of Cardiothoracic Surgery,Nanjing Drum Tower Hospital,from July 2019 to July 2020,including 55 and 15 men and women,aged 49-82 years,respectively.Patients were divided into a group of 10 based on the order in which they underwent the procedure,and there were seven groups,in the order of S1-S7 groups,to observe and compare the baseline data of the seven groups and obtain the saphenous vein length(L),time(T),number of injuries,and L/T ratio.The 70 patients were divided into pre-and post-inflection point groups based on the learning curve inflection point,and the baseline data as well as each of the above-mentioned indexes were compared between the two groups.Results No statistically significant difference was found in the baseline data of patients in the seven groups from S1 to S7 in terms of sex,age,diabetes mellitus,and hypertension(all P values>0.05).The saphenous vein acquisition time,saphenous vein injury number,and L/T ratio were statistically different(F=4.95,3.85,5.12,all P values<0.001).The S7 group had the shortest saphenous vein acquisition time,the least saphenous vein injury number and the highest L/T ratio.Meanwhile,the S1 group took the longest time to obtain the great saphenous vein,had the most damage to the great saphenous vein,and had the lowest L/T ratio,and the differences between groups were statistically significant.No statistically significant difference was observed in the length of the great saphenous vein obtained(F=0.69,P=0.056).Pearson correlation analysis showed that there was a positive correlation between the L/T ratio and the number of surgical cases(i.e.,the number of great saphenous veins obtained by endoscopy)(r=0.79,P<0.001)and the L/

关 键 词：学习曲线 冠状动脉旁路移植术 大隐静脉获取 外科手术 微创性 

分 类 号：R654.2[医药卫生—外科学]