在食道内镜下粘膜剖析中,培训人员的技术困难的预测因素
Tomoya Ueda1, Ryu Ishihara2, Shunsuke Yoshii1
1Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan.
Esophagus : official journal of the Japan Esophageal Society
|December 11, 2023
概括
预测食道内镜下粘膜切割 (ESD) 中的技术困难对于学员至关重要. 大型瘤,痕附近的瘤和左侧瘤增加了难度,而上部食道瘤减少了难度.
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:
- 消化管内镜下粘膜切割 (ESD) 给学员带来了重大的技术挑战.
- 对食道ESD进行安全有效的培训系统至关重要.
- 识别技术困难的预测因素是开发这种系统的关键.
研究的目的:
- 为了确定实习生在执行食道ESD时遇到的技术困难的预测因素.
- 为实习生建立一个预测系统,以评估食道ESD程序的难度.
主要方法:
- 从2010年1月到2022年8月,由实习生对798例食道癌病变进行了回顾性单一中心研究,这些病变在2010年1月至2022年8月期间接受了ESD治疗.
- 技术困难被定义为肌肉自身暴露和手术时间≥90分钟.
- 用多变量分析来调查与这些困难相关的因素.
主要成果:
- 肌肉自身暴露发生在37.3%的病例中,而长时间的手术时间 (≥90分钟) 在16.8%中.
- 瘤大小 (≥20毫米),瘤周长 (≥1/2) 和接近痕增加了难度.
- 上部食道瘤的难度降低,而女性的性别和左壁位置预测了肌肉本身的暴露. 升高的形态预测了更长的手术时间.
结论:
- 在手术前确定诸如巨大的瘤大小和痕的近距离等因素,可以预测受训人员食道ESD的技术难度增加.
- 上部食道的瘤与难度降低有关.
- 这些发现促进了手术前的难度评估,并指导了对食道ESD的逐步培训选择.
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