摘要
目的探讨CT引导下经皮肺穿刺活检术学习曲线。方法采用累积和(cumulative sum,CUSUM)分析法分析2024年5月至10月在郑州大学第一附属医院由同一医师完成CT引导下经皮肺穿刺活检术的110例患者临床资料。对CUSUM学习曲线进行拟合,以R2判断拟合优度。比较学习曲线不同阶段患者基线和围手术期资料,以确定由学习阶段进入熟练阶段所需累积手术例数。结果所有患者穿刺活检术均顺利完成,操作时长为(20.2±3.4)min(15~29 min),随手术例数积累呈逐渐下降趋势。学习曲线最佳拟合为三次方曲线,拟合优度系数R^(2)=0.991,拟合方程:CUSUM值(110)=0.0003x^(3)-0.0813x^(2)+5.5979x+0.7743(x为手术例数)。拟合曲线在手术例数积累至第46例达到顶点,以此为分界分为学习阶段和熟练阶段。熟练阶段操作时长显著低于学习阶段[(18.33±2.31)min比(22.80±3.02)min,P<0.001],气胸并发症发生率显著低于学习阶段(18.8%比37.0%,P=0.033)。结论CUSUM分析法精确分析110例CT引导下经皮肺穿刺活检术学习曲线表明,掌握这项技术需累积手术例数46例。
Objective To investigate the learning curve of CT-guided percutaneous lung biopsy.Methods Using cumulative sum(CUSUM)analysis method,the clinical data from110 patients,who underwent CT-guided percutaneous lung biopsy performed by the same physician at the First Affiliated Hospital of Zhengzhou University of China between May 2024 and October 2024,were retrospectively analyzed.The CUSUM learning curve was fitted,and R2 was used to assess the goodness of fit.The baseline and perioperative data were compared between different stages of the learning curve so as to determine the number of accomplished surgical cases that was required for a physician to reach the proficiency stage from the learning stage in performing CT-guided percutaneous lung biopsy.Results Successful CT-guided percutaneous lung biopsy was accomplished in all patients,with a mean operation time of(20.2±3.4)minutes(range of 15-29 minutes).With the accumulation of surgical cases,the operation time showed a gradual downward trend.The learning curve was best fitted with a cubic equation,the equation was as follows:CUSUM(110)=0.0003x^(3)-0.0813x^(2)+5.5979x+0.7743(where xrepresenting the number of cases),with a goodness-of-fit coefficient R^(2)=0.991.The fitted curve reached its peak at the performance of the 46th case,which was used as the cutoff point to divide the learning curve into two phases.Compared with the learning phase,in the proficiency phase the incidence of complications was significantly lower(pneumothorax:18.8%vs 37.0%,P=0.033)and the mean operation time was obviously shorter[(18.33±2.31)min vs(22.80±3.02)min,P<0.001].Conclusion Through precise CUSUM analysis of the learning curves obtained from 110 patients receiving CT-guided percutaneous lung biopsy,the results of this study indicates that it requires to accomplish 46 operations before a physician can skillfully master the technique of CT-guided percutaneous lung biopsy.
作者
李亚丹
王猛
杜可朴
李帅
高飞
高梦宇
黄清博
陈林
周志刚
LI Yadan;WANG Meng;DU Kepu;LI Shuai;GAO Fei;GAO Mengyu;HUANG Qingbo;CHEN Lin;ZHOU Zhigang(Department of Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,China)
出处
《介入放射学杂志》
北大核心
2025年第7期784-788,共5页
Journal of Interventional Radiology
基金
希思科-领航肿瘤研究基金(Y-2019AZMS-0505)。
关键词
累积和分析
肺穿刺活检
CT引导
学习曲线
cumulative sum analysis
percutaneous lung biopsy
CT guidance
learning curve
