经皮主动脉腔内修复术的学习曲线初探
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摘要
目的探讨完全经皮主动脉腔内修复术(percutaneous endovascular aortic repair,PEVAR)的学习曲线。方法回顾性分析2012年12月~2015年8月我科同一主治医师完成的40例PEVAR的临床资料,按手术时间顺序分为4组(G1~G4组),每组10例,对4组手术时间、技术成功率、并发症、出血量、缝合器数量进行比较。结果 G1组手术时间(19.9±4.3)min,显著长于G2组(16.4±3.9)min、G3组(10.4±2.1)min和G4组(10.3±1.5)min(q=3.484,P<0.05;q=9.458,P<0.05;q=9.557,P<0.05),G2组手术时间明显长于G3组和G4组(q=5.973,P<0.05;q=6.073,P<0.05),G3组和G4组手术时间无统计学差异(q=0.100,P>0.05)。G1、G2组技术成功率均为80%,与G3、G4组(均为100%)无统计学差异(χ~2=4.444,P=0.217)。4组在并发症、出血量和使用缝合器数量方面无统计学差异(P>0.05)。结论 PEVAR存在学习曲线,20例后完成PEVAR学习曲线。
Objective To investigate the learning curve of percutaneous endovascular aortic repair( PEVAR). Methods A retrospective analysis of clinical data of 40 cases of PEVAR performed by a vascular surgeon from December 2012 to August 2015 in our hospital was made. According to the operation date,all the cases were divided into 4 groups( G1- G4) with 10 cases in each group. The data of 4 groups was analyzed including the operation time,technical success rate,complications,blood loss and number of vascular closure devices. Results The operation time in G1 was significantly longer than that in G2,G3,and G4 [( 19. 9 ± 4. 3)min vs.( 16. 4 ± 3. 9) min,q = 3. 484,P < 0. 05;( 19. 9 ± 4. 3) min vs.( 10. 4 ± 2. 1) min,q = 9. 458,P < 0. 05;( 19. 9 ± 4. 3)min vs.( 10. 3 ± 1. 5) min,q = 9. 557,P < 0. 05]. The operation time of G2 was also longer than that in G3 and G4 [( 16. 4 ± 3. 9)min vs.( 10. 4 ± 2. 1) min,q = 5. 973,P < 0. 05;( 16. 4 ± 3. 9) min vs.( 10. 3 ± 1. 5) min,q = 6. 073,P < 0. 05] and there was no significant difference between G3 and G4( q = 0. 100,P > 0. 05). There was no statistical difference( P > 0. 05) in technical success rate between G1( 80%),G2( 80%),G3( 100%),and G4( 100%). No significant difference was found in complications,blood loss and number of vascular closure devices among the 4 groups( P > 0. 05). Conclusions PEVAR is a gradual process and there is a learning curve. The operation time is significantly shorter and technical success rate is improved after the completion of 20 cases.
Objective To investigate the learning curve of percutaneous endovascular aortic repair( PEVAR). Methods A retrospective analysis of clinical data of 40 cases of PEVAR performed by a vascular surgeon from December 2012 to August 2015 in our hospital was made. According to the operation date,all the cases were divided into 4 groups( G1- G4) with 10 cases in each group. The data of 4 groups was analyzed including the operation time,technical success rate,complications,blood loss and number of vascular closure devices. Results The operation time in G1 was significantly longer than that in G2,G3,and G4 [( 19. 9 ± 4. 3)min vs.( 16. 4 ± 3. 9) min,q = 3. 484,P < 0. 05;( 19. 9 ± 4. 3) min vs.( 10. 4 ± 2. 1) min,q = 9. 458,P < 0. 05;( 19. 9 ± 4. 3)min vs.( 10. 3 ± 1. 5) min,q = 9. 557,P < 0. 05]. The operation time of G2 was also longer than that in G3 and G4 [( 16. 4 ± 3. 9)min vs.( 10. 4 ± 2. 1) min,q = 5. 973,P < 0. 05;( 16. 4 ± 3. 9) min vs.( 10. 3 ± 1. 5) min,q = 6. 073,P < 0. 05] and there was no significant difference between G3 and G4( q = 0. 100,P > 0. 05). There was no statistical difference( P > 0. 05) in technical success rate between G1( 80%),G2( 80%),G3( 100%),and G4( 100%). No significant difference was found in complications,blood loss and number of vascular closure devices among the 4 groups( P > 0. 05). Conclusions PEVAR is a gradual process and there is a learning curve. The operation time is significantly shorter and technical success rate is improved after the completion of 20 cases.
引文
1 Rudarakanchana N,Reeves BC,Bicknell CD,et al.Editor’s choice-treatment decisions for descending thoracic aneurysm:preferences for thoracic endovascular aneurysm repair or surveillance in a discrete choice experiment.Eur J Vasc Endovasc Surg,2014,48(1):13-22.
2戈小虎,方青波,管圣,等.Stanford B型主动脉夹层的腔内治疗(附134例报告).中国微创外科杂志,2012,12(9):774-776.
3 Moll FL,Powell JT,Fraedrich G,et al.Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.Eur J Vasc Endovasc Surg,2011,41(Suppl1):S1-S58.
4 Dangas G,O’Connor D,Firwana B,et al.Open versus endovascular stent graft repair of abdominal aortic aneurysms.JACC:Cardiol Intv,2012,5(10):1071-1080.
5 Haas PC,Krajcer Z,Diethrich EB.Closure of large percutaneous access sites using the Prostar XL percutaneous vascular surgery device.J Endovasc Surg,1999,6(2):168-170.
6 Carlos FB,Neal RB,George P,et al.Predicting the learning curve and failures of total percutaneous endovascular aortic aneurysm repair.J Vasc Surg,2013,57(1):72-76.
7 Nelson PR,Kracjer Z,Kansal N,et al.A multicenter,randomized,controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair(the PEVAR trial).J Vasc Surg,2014,59(5):1181-1193.
8 Metcalfe MJ,Brownrigg JR,Black SA,et al.Unselected percutaneous access with large vessel closure for endovascular aortic surgery:experience and predictors of technical success.Eur J Vasc Endovasc Surg,2012,43(4):378-381.
9蒋京军,卿洪琨,张小明,等.经皮穿刺缝合与股动脉切开在主动脉瘤腔内修复术中的对照研究.北京大学学报(医学版),2016,8(5):850-854.
10 Lee WA,Brown MP,Nelson PR,et al.Total percutaneous access for endovascular aortic aneurysm repair(“Preclose”technique).JVasc Surg,2007,45(6):1095-1101.
11 Malkawi AH,Hinchliffe RJ,Holt PJ,et al.Percutaneous access for endovascular aneurysm repair:a systematic review.Eur J Vasc Endovasc Surg,2010,39(6):676-682.
12 Teh LG,Sieunarine K,van Schie G,et al.Use of the percutaneous vascular surgery device for closure of femoral access sites during endovascular aneurysm repair:lessons from our experience.Eur JVasc Endovasc Surg,2001,22(5):418-423.
13 Morasch MD.Percutaneous thoracic and abdominal aortic aneurysm repair.Ann Vasc Surg,2005,19(4):585-589.
14 Jean-Baptiste E,Hassen-Khodja R,Haudebourg P,et al.Percutaneous closure devices for endovascular repair of infrarenal abdominal aortic aneurysms:a prospective,non-randomized comparative study.Eur J Vasc Endovasc Surg,2008,35(4):422-428.
15 Eisenack M,Umscheid T,Tessarek J,et al.Percutaneous endovascular aortic aneurysm repair:a prospective evaluation of safety,efficiency,and risk factors.J Endovasc Ther,2009,16(6):708-713.
16 Starnes BW,Andersen CA,Ronsivalle JA,et al.Totally percutaneous aortic aneurysm repair:experience and prudence.JVasc Surg,2006,43(2):270-276.
17 Mousa AY,Campbell JE,Broce M,et al.Predictors of percutaneous access failure requiring open femoral surgical conversion during endovascular aortic aneurysm repair.J Vasc Surg,2013,58(5):1213-1219.
18 Watelet J,Gallot JC,Thomas P,et al.Percutaneous repair of aortic aneurysms:a prospective study of suture-mediated closure devices.Eur J Vasc Endovasc Surg,2006,32(3):261-265.
19叶鹏,陈勇,曾庆乐,等.血管缝合器预缝合技术完全经皮穿刺途径完成主动脉腔内修复术后的股动脉中长期随访结果.南方医科大学学报,2014,34(5):747-750.
20 Bechara CF,Barshes NR,Pisimisis G,et al.Predicting the learning curve and failures of total percutaneous endovascular aortic aneurysm repair.J Vasc Surg,2013,57(1):72-76.
2戈小虎,方青波,管圣,等.Stanford B型主动脉夹层的腔内治疗(附134例报告).中国微创外科杂志,2012,12(9):774-776.
3 Moll FL,Powell JT,Fraedrich G,et al.Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.Eur J Vasc Endovasc Surg,2011,41(Suppl1):S1-S58.
4 Dangas G,O’Connor D,Firwana B,et al.Open versus endovascular stent graft repair of abdominal aortic aneurysms.JACC:Cardiol Intv,2012,5(10):1071-1080.
5 Haas PC,Krajcer Z,Diethrich EB.Closure of large percutaneous access sites using the Prostar XL percutaneous vascular surgery device.J Endovasc Surg,1999,6(2):168-170.
6 Carlos FB,Neal RB,George P,et al.Predicting the learning curve and failures of total percutaneous endovascular aortic aneurysm repair.J Vasc Surg,2013,57(1):72-76.
7 Nelson PR,Kracjer Z,Kansal N,et al.A multicenter,randomized,controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair(the PEVAR trial).J Vasc Surg,2014,59(5):1181-1193.
8 Metcalfe MJ,Brownrigg JR,Black SA,et al.Unselected percutaneous access with large vessel closure for endovascular aortic surgery:experience and predictors of technical success.Eur J Vasc Endovasc Surg,2012,43(4):378-381.
9蒋京军,卿洪琨,张小明,等.经皮穿刺缝合与股动脉切开在主动脉瘤腔内修复术中的对照研究.北京大学学报(医学版),2016,8(5):850-854.
10 Lee WA,Brown MP,Nelson PR,et al.Total percutaneous access for endovascular aortic aneurysm repair(“Preclose”technique).JVasc Surg,2007,45(6):1095-1101.
11 Malkawi AH,Hinchliffe RJ,Holt PJ,et al.Percutaneous access for endovascular aneurysm repair:a systematic review.Eur J Vasc Endovasc Surg,2010,39(6):676-682.
12 Teh LG,Sieunarine K,van Schie G,et al.Use of the percutaneous vascular surgery device for closure of femoral access sites during endovascular aneurysm repair:lessons from our experience.Eur JVasc Endovasc Surg,2001,22(5):418-423.
13 Morasch MD.Percutaneous thoracic and abdominal aortic aneurysm repair.Ann Vasc Surg,2005,19(4):585-589.
14 Jean-Baptiste E,Hassen-Khodja R,Haudebourg P,et al.Percutaneous closure devices for endovascular repair of infrarenal abdominal aortic aneurysms:a prospective,non-randomized comparative study.Eur J Vasc Endovasc Surg,2008,35(4):422-428.
15 Eisenack M,Umscheid T,Tessarek J,et al.Percutaneous endovascular aortic aneurysm repair:a prospective evaluation of safety,efficiency,and risk factors.J Endovasc Ther,2009,16(6):708-713.
16 Starnes BW,Andersen CA,Ronsivalle JA,et al.Totally percutaneous aortic aneurysm repair:experience and prudence.JVasc Surg,2006,43(2):270-276.
17 Mousa AY,Campbell JE,Broce M,et al.Predictors of percutaneous access failure requiring open femoral surgical conversion during endovascular aortic aneurysm repair.J Vasc Surg,2013,58(5):1213-1219.
18 Watelet J,Gallot JC,Thomas P,et al.Percutaneous repair of aortic aneurysms:a prospective study of suture-mediated closure devices.Eur J Vasc Endovasc Surg,2006,32(3):261-265.
19叶鹏,陈勇,曾庆乐,等.血管缝合器预缝合技术完全经皮穿刺途径完成主动脉腔内修复术后的股动脉中长期随访结果.南方医科大学学报,2014,34(5):747-750.
20 Bechara CF,Barshes NR,Pisimisis G,et al.Predicting the learning curve and failures of total percutaneous endovascular aortic aneurysm repair.J Vasc Surg,2013,57(1):72-76.