在初始学习曲线期间进行无监督内镜下膜剖析的预测因素,以流行率为基础的指示
Ingo Steinbrück1, Siegbert Faiss2, Franz Ludwig Dumoulin3
1Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital of University of Freiburg, Wirthstraße 11, 79110, Freiburg, Germany. ingo.steinbrueck@diak-fr.de.
Digestive diseases and sciences
|July 8, 2023
概括
对于新手内镜师学习内镜下膜剖析 (ESD),避免预先处理的病变和结肠手术. 在最初的学习曲线中,损伤的大小和位置对成功的结果不那么重要.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 医学教育 医学教育
背景情况:
- 建立有效的内镜下粘膜切割 (ESD) 培训计划对于非亚洲医疗保健机构至关重要.
- 在没有直接专家监督的情况下,为初学者定义适合的病变对于适当的教育策略至关重要.
研究的目的:
- 在ESD的初始学习曲线中确定有效性和安全性的预测因素.
- 为独立执行ESD的实习生选择合适的案例提供指导.
主要方法:
- 分析了四个第三级医院的四个运营商 (2007-2020年) 进行的前120次ESD程序 (共480次).
- 单变量和多变量回归分析,以评估诸如损伤特征,器官和局部化等预测因素,用于块切除 (EBR),并发症和切除速度.
主要成果:
- 整体率:84.5%的EBR,14.2%的并发症,6.20厘米/小时的切除速度.
- 预先治疗的病变显著预测了较低的EBR,更高的并发症率和更慢的切除速度.
- 与结肠ESD相比,非结肠部位 (直肠,胃,食道) 与更高的EBR率有关.
结论:
- 在最初的无监督ESD学习曲线期间,避免预处理的病变和结肠ESD.
- 损伤大小和特定器官的局部化对手术结果的预测价值有限.
- 这些发现有助于优化初学者内镜师的ESD培训和患者选择.
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