[1]陈彧,万峰.初学者第1个100例非体外循环冠状动脉旁路移植术体会[J].中国微创外科杂志,2006,06(11):842-844.
　Chen Yu,Wan Feng..First 100 cases of off-pump coronary artery bypass grafting: Experience from a training cardiac surgeon[J].Chinese Journal of Minimally Invasive Surgery,2006,06(11):842-844.
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初学者第1个100例非体外循环冠状动脉旁路移植术体会()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
06
期数:
2006年11期
页码:
842-844
栏目:
出版日期:
2006-11-30

文章信息/Info

Title:
First 100 cases of off-pump coronary artery bypass grafting: Experience from a training cardiac surgeon
作者:
陈彧; 万峰　
北京大学人民医院心脏外科,北京,100044
Author(s):
Chen Yu;  Wan Feng.
Department of Cardiac Surgery, Peking UniversityPeople’s Hospital, Beijing 100044, China
关键词:
冠状动脉旁路移植术; 非体外循环; 学习曲线
Keywords:
Coronary artery bypass grafting; 　Off pump; 　Learning curve
分类号:
R654.2
文献标志码:
A
摘要:
目的 报道初学者第1个100例非体外循环冠状动脉旁路移植术(off pump coronary artery bypass,OPCAB),探讨培训方法的可行性.方法 受训者是一名没有冠脉外科经验的心脏外科医生,在一名具有丰富OPCAB手术经验的指导者指导下,培训28个月开始独立主刀OPCAB手术.选取受训者独立完成的连续第1个100例手术(受训组),以指导者连续100例OPCAB手术作为对照(指导组),进行对比研究.结果 受训组中有5例中转体外循环手术.远端吻合口数目为(2.9±0.6)个,明显少于指导组(3.5±0.7)个(t=-6.508,P=0.001);受训组回旋支血管桥的比例(67/100 vs 88/100,x2=12.645,P=0.000)和序贯吻合的比例(3/100 vs.27/100,x2=22.588,P=0.000)均明显小于指导组.受训组病死率为3%(3例),指导组为1%(1例),2组无显著性差异(x2=0.255,P=0.614).2组其他术后并发症均没有统计学差别(P＞0.05).结论 受训者第1个100例OPCAB手术的结果是可以接受的,标志着受训者从技术培训阶段向技术独立阶段的平稳过渡,验证这种技术培训方法的可行性.
Abstract:
Objective　To report the experience of first100 cases ofoff-pump coronary artery bypass (OPCAB) grafting by a training cardiac surgeon, and to discuss the feasibility of the training method.　M ethods　The trainee, who had no previous experience of coronary surgery, received an OPCAB training program under the guidance by a directorwho had completed more than 2000 casesOPCAB. After28 months of training, the trainee began to be an independentoperator. The data of the firstconsecutive 100 cases ofOPCAB by the trainee (Training Group) were collected for comparison with the director’s 100 cases of OPCAB surgery (ControlGroup).　Results　There were 5 cases of conversion to on-pump surgery in the Training Group. The number of distal anastmosis in the TrainingGroup (2. 9±0. 6) was smaller than that in the ControlGroup (3. 5±0. 7) (t=-6·508, P=0·001). Compared with the ControlGroup, there were less circumflex grafts (67/100 vs 88/100;χ2=12.645, P=0. 000) and sequential grafts (3/100 vs27/100;χ2=22.588, P=0. 000) in theTrainingGroup. Therewas no significantdifference inmortality between the TrainingGroup (3%, 3 cases) and the Control Group (1%, 1 case) (χ2=0.255, P=0. 614). No significant difference was observed between the two groups in other postoperative severe complications.　Conclusions　The first 100 cases ofOPCAB surgery performed by the trainee give favorable results, indicating a stable transition from training period to independent performance. It also testifies the feasibility of this training program.

参考文献/References:

[1]Murphy GJ,Rogers CA,Caputo M,et al.Acquiring proficiency in off-pump surgery:traversing the learning curve.reproducibility,and quality control.Ann Thorac Surg,2005,80(5):1965 -1970.
[2]万峰,陈彧,江龙.1198例非体外循环冠状动脉搭桥术的早期临床分析.中华胸心血管外科杂志,2003,19(1):16-18.
[3]Eagle KA,Guyton RA,Davidff R,et al.ACC/AHA guidelines for coronary artery bypass graft surgery.J Am Coll Cardiol,1999,34:1262-1347.
[4]Novick RJ,Fox SA,Stitt LW,et al.Assessing the learning curve in off-pump coronary artery surgery via CUSUM failure analysis.Ann Thorac Surg,2002,73 (1):S358-S362.

更新日期/Last Update: 2014-03-03