对非功能良性甲状腺结节进行射频废除手术的熟练程度:这是一个定性而不是定量问题
Spyridon Chytiris1, Marsida Teliti1,2, Laura Croce1,2
1Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
Frontiers in endocrinology
|June 27, 2024
概括
对良性甲状腺结节 (BTN) 的射频切除 (RFA) 有一个学习曲线 (LC),这取决于结节的大小. 对大结节 (>25毫升) 无法达到操作人员的熟练程度,这表明其他因素也会影响结果.
科学领域:
- 内分泌学 在内分泌学.
- 最少侵入性的手术
- 医疗技术 医疗技术 医学技术
背景情况:
- 射频切除 (RFA) 是一种对良性甲状腺结节 (BTN) 的微创,非手术治疗方法.
- 虽然RFA证明了BTN的良好的安全概况,但运营商达到熟练程度的学习曲线 (LC) 尚未明确定义.
- 了解LC对于优化患者的治疗结果和标准化RFA程序至关重要.
研究的目的:
- 定义用于治疗良性甲状腺结节 (BTN) 的射频切除 (RFA) 的学习曲线 (LC).
- 评估结核大小对操作者的学习曲线和治疗疗效的影响.
- 确定影响BTNRFA成功率的因素.
主要方法:
- 追溯分析179个RFA手术,由单个操作员在BTN不功能患者身上进行.
- 熟练程度定义为达到6个月结节体积减少率 (VRR) ≥50%.
- 用于评估LCs的累积和 (CUSUM) 图表,按基底结节大小分层 (小<10毫升,中等10-25毫升,大>25毫升).
主要成果:
- 整体LC包括三个阶段:初始学习 (1-39),巩固 (40-145) 和经验 (146-179程序).
- 对于小结节和中等结节,熟练程度较早达到 (总体而言,分别是第37个和第116个程序).
- 对大结节 (>25毫升) 没有证明操作人员的熟练程度,预计体积减少率低于最佳.
结论:
- 在良性甲状腺结节中RFA的学习曲线受到基底结节大小的显著影响.
- 在用RFA治疗的大型结节 (>25毫升) 时,应预计体积减少率低于最佳.
- 从治疗较小结节的经验中获得的经验似乎没有提高对较大的结节的RFA疗效,这表明其他因素至关重要.
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