[1]高永山** 张振明 金凤仙 董跃华 姜伟华 王大伟 魏玉磊.经皮胸主动脉腔内修复术中使用Perclose ProGlide血管缝合器行预先埋置缝合技术的学习曲线[J].中国微创外科杂志,2021,01(4):298-302.
　Gao Yongshan,Zhang Zhenming,Jin Fengxian,et al.Learning Curve of Preclosure Technique Using Perclose ProGlide Vascular Closure Devices in Percutaneous Thoracic Endovascular Aortic Repair[J].Chinese Journal of Minimally Invasive Surgery,2021,01(4):298-302.
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经皮胸主动脉腔内修复术中使用Perclose ProGlide血管缝合器行预先埋置缝合技术的学习曲线()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年4期
页码:
298-302
栏目:
临床论著
出版日期:
2021-04-25

文章信息/Info

Title:
Learning Curve of Preclosure Technique Using Perclose ProGlide Vascular Closure Devices in Percutaneous Thoracic Endovascular Aortic Repair
作者:
高永山** 张振明 金凤仙 董跃华 姜伟华 王大伟 魏玉磊
（河北北方学院附属第一医院胸心外科，张家口075000）
Author(s):
Gao Yongshan;  Zhang Zhenming;  Jin Fengxian;  et al.
Department of Thoracic and Cardiovascular Surgery,The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
关键词:
预先埋置缝合技术; 经皮胸主动脉腔内修复术; 学习曲线; CUSUM分析
Keywords:
Preclosure technique; Percutaneous thoracic endovascular aortic repair; Learning curve; CUSUM analysis
文献标志码:
A
摘要:
目的探讨经皮胸主动脉腔内修复术时应用Perclose ProGlide血管缝合器行预先埋置缝合技术的学习曲线。方法回顾性分析2016年9月~2020年5月同一手术团队连续完成的应用Perclose ProGlide血管缝合器行预先埋置缝合技术实施经皮胸主动脉腔内修复术93例的临床资料，使用累积和（cumulative sum，CUSUM）方法分析其学习曲线，并对学习曲线不同阶段的预置缝合器操作时间、预置缝合器出血量、腹股沟区入路相关并发症发生率及总技术失败率进行比较。结果CUSUM学习曲线最佳拟合方程为y=-3.085+1.91x-0.03614x2+2.227e-4x3-5.141e-7x4，拟合优度R2=0.9861，拟合曲线在手术例数累积至第38例后斜率变为负值，以此为界将其划分为2个阶段，A阶段为学习提高阶段（n=38），B阶段为熟练掌握阶段（n=55）。B阶段预置缝合器操作时间及出血量优于A阶段（P<0.05），而腹股沟区入路相关并发症发生率及总技术失败率两阶段差异无显著性（P>0.05）。结论胸心外科手术团队在经皮胸主动脉腔内修复术中使用Perclose ProGlide血管缝合器行预先埋置缝合技术经38例手术趋于稳定。
Abstract:
ObjectiveTo explore the learning curve of total percutaneous thoracic endovascular aortic repair (TEVAR) with the preclosure technique using Perclose ProGlide.MethodsWe retrospectively analyzed clinical data of 93 consecutive patients who underwent total percutaneous TEVAR with the preclosure technique using Perclose ProGlide devices by the same team from September 2016 to May 2020. The cumulative sum analysis (CUSUM) was used to analyze the learning curve, and the operating time of preclosure technique, the blood loss of preclosure technique, the groin complication rate and the total technical failure rate were compared.ResultsThe CUSUM learning curve were best modeled as a polynomial with equation: y=-3.085+1.91x-003614x2+2.227e-4x3-5.141e-7x4, with goodnessoffit (R2) as 0.9861. The fitting curve slope turned into negative at the 38th case, and the learning curve were divided into learning stage（stage A, n=38）and mastery stage（stage B, n=55）with 38 cases as the cut off point. The operative time and blood loss of preclosure technique in stage B was significantly better than that in stage A (P<005). The two stages were similar in terms of the rate of the groin complication and the total technical failure (P>0.05).ConclusionThe safety of TEVAR with the preclosure technique using Perclose ProGlide vascular closure devices by same team of cardiothoracic surgery tends to be stable after approximately 38 cases of operation.

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备注/Memo

备注/Memo:
基金项目：河北省医学科学研究课题(20190884)**通讯作者，Email:gaoyongshan3333@163.com
更新日期/Last Update: 2021-06-30