背景:尽管可以使用微创手术快速进行经皮中心静脉端口(CVP)放置,可发生短期和长期并发症。初学者儿科外科医生必须克服影响手术时间和并发症发生率的学习曲线。然而,关于超声引导经皮CVP放置的学习曲线的研究很少。本研究分析了进展,结果,并发症,以及由一名初级儿科外科医生进行的超声引导下经皮CVP放置在儿童中的学习曲线。
方法:回顾了30例接受超声引导经皮CVP置入术的儿童的数据。病人的特点,程序指示,进入静脉,操作员位置,手术时间,并对并发症发生率进行分析。
结果:累积和分析揭示了学习曲线的两个阶段:阶段1(最初的15例)和阶段2(随后的病例)。病例数与手术时间之间存在相关性(Pearson相关性=-0.499,p=0.005);第一阶段的手术时间明显长于第二阶段(p=0.007)。虽然手术并发症发生在早期(26.7%)比晚期更频繁,这两个阶段之间没有显着差异(p=0.1)。在学习期间,由于操作者的位置从患者右侧到患者头部的改变,手术时间显著缩短(p=0.005).
结论:超声引导下的经皮CVP置入术是一种安全的手术,使初学的儿科外科医生仅在15例病例后就可以克服学习曲线,并且与其他儿科手术相比,并发症数量相对较少。此外,手术者的合适位置影响手术结局.
BACKGROUND: Although percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon.
METHODS: Data from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed.
RESULTS: Cumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator\'s position from the patient\'s right side to the patient\'s head (p = 0.005).
CONCLUSIONS: Ultrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.