摘要
目的探讨结直肠病变行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)的学习曲线。方法回顾性分析2019年8月~2020年12月我院内镜中心ESD治疗结直肠病变的临床资料,手术均由我院同一位有食管和胃ESD经验的内镜专家完成。利用累积和(cumulative sum,CUSUM)曲线分析手术切除速度,通过CUSUM曲线分析确定各阶段的中位手术时间、整块切除、完全切除、不良事件发生率。结果CUSUM曲线的拐点可分为4个阶段,分别为25、31、28、28例。切除速度第2阶段较第1阶段明显提高[8.5(8.1,8.5)mm^(2)/min vs.5.3(4.4,5.7)mm^(2)/min,Z=-2.715,P=0.040],第3阶段切除速度显著高于第2阶段[14.1(13.5,15.2)mm^(2)/min vs.8.5(8.1,8.5)mm^(2)/min,Z=-3.479,P=0.003],第4阶段较第3阶段切除速度进一步提高[17.3(15.6,21.7)mm^(2)/min vs.14.1(13.5,15.2)cm^(2)/min,Z=-2.843,P=0.027]。ESD切除时间第3阶段较第2阶段明显缩短(Z=2.850,P=0.026),第4阶段与第3阶段差异无显著性(Z=-1.963,P=0.298),但第4阶段的病变面积较第3阶段明显增大(Z=-3.189,P=0.009)。4个阶段整块切除率、R0切除率、治愈性切除率无统计学差异(P>0.05)。不良事件发生率第3、4阶段较第1阶段显著下降(均P=0.043)。结论对于有食管和胃ESD经验的术者,掌握结直肠ESD需要25例的积累,达到熟练程度需要56例的积累。
Objective To analyze the learning curve of endoscopic submucosal dissection(ESD)for colorectal lesions.Methods Patients with colorectal lesions treated by ESD in our endoscopy center from August 2019 to December 2020 were enrolled and the operations were performed by the same endoscopic expert with experience in esophageal and gastric ESD.The resection speed was analyzed by using the cumulative sum(CUSUM)curve.The median surgical time,en bloc resection,complete resection,and adverse event rate in different stages were determined by CUSUM curve analysis.Results The CUSUM curve can be divided into four different stages.Compared with the first stage,the resection speed in the second stage was significantly improved[8.5(8.1,8.5)mm^(2)/min vs.5.3(4.4,5.7)mm^(2)/min,Z=-2.715,P=0.040].The resection speed in the third stage was higher than that in the second stage[14.1(13.5,15.2)mm^(2)/min vs.8.5(8.1,8.5)mm^(2)/min,Z=-3.479,P=0.003].Compared with the third stage,the resection speed in the fourth stage was further improved[17.3(15.6,21.7)mm^(2)/min vs.14.1(13.5,15.2)mm^(2)/min,Z=-2.843,P=0.027].The resection time in the third stage was significantly shorter than that in the second stage(Z=2.850,P=0.026).There was no statistical difference in the resection time between the fourth stage and the third stage(Z=-1.963,P=0.298),but the lesion area in the fourth stage increased significantly compared to the third stage(Z=-3.189,P=0.009).There were no statistical differences in the en bloc resection rate,R0 resection rate,and curative resection rate in the four stages(P>0.05).For the incidence of adverse events,the third and fourth stages showed a significant decrease compared to the first stage(both P=0.043).Conclusion For surgeons with experience in esophageal and gastric ESD,mastering colorectal ESD requires an accumulation of 25 cases and about 56 cases to achieve proficiency.
作者
刘晓
于剑锋
王燕斌
刘振
张冬磊
刘振越
刘心娟
Liu Xiao;Yu Jianfeng;Wang Yanbin(Department of Gastroenterology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第6期436-441,共6页
Chinese Journal of Minimally Invasive Surgery
关键词
结直肠病变
内镜黏膜下剥离术
累积和曲线
切除速度
Colorectal lesions
Endoscopic submucosal dissection
Cumulative sum curve
Resection speed
