结构化培训和初级胸部外科医生主要肺切除的早期结果:一项回顾性观察性研究
1Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Journal of thoracic disease
|November 13, 2025
概括
一位初级胸部外科医生在三年内获得了主要肺切除的熟练程度,包括视频辅助胸腔镜手术 (VATS) 叶切除术和细分切除术. 与分片切除术相比,分片切除术的早期采用显示了更快的学习曲线和更好的结果.
科学领域:
- 胸部外科手术 胸部外科手术
- 外科教育的外科教育
- 最少侵入性手术的方法
背景情况:
- 在视频辅助胸腔镜外科手术 (VATS) 中,初级胸部外科医生的学习曲线并不清楚,通常需要50-60个案例才能熟练.
- 本研究检查了单个初级胸部外科医生的手术进展和结果,超过三年的独立实践.
- 专注于主要的肺切除术,包括将细分切除术纳入实践.
研究的目的:
- 评估初级胸部外科医生在最初三年独立实践期间的学习曲线和外科结果.
- 评估执行主要肺切除术的进展情况,特别是分管切除术和分管切除术.
- 为了比较分片切除术与分片切除术的周围手术结果.
主要方法:
- 从2022年6月到2025年6月,由一名外科医生进行的402次胸部手术的回顾性审查.
- 分析包括123个主要的肺切除术 (75个小管切除术,48个细分切除术) 来治疗各种疾病.
- 评估了手术时间,血液损失和病例数量的季度趋势;CUSUM分析用于评估113例初级肺癌病例的熟练程度.
主要成果:
- 主要的肺切除体积稳步增加,截至2025年,细分切除占病例的46%.
- 手术时间显著减少 (207.5分钟至152.6分钟),血液损失减少 (从200毫升至80毫升).
- 与分片切除术相比,分片切除术的手术时间 (139.8分钟对175.0分钟) 和麻醉时间更短,血液损失更少 (42.1毫升对94.1毫升),住院时间更短 (7.0天对10.3天),并出现类似的并发症/死亡率.
结论:
- 一种结构化,逐步的方法在主要的肺切除中促进了安全和高效的早期职业成果.
- 尽管分段切除术技术复杂,但在分段切除术方面的熟练程度比分分切除术 (26例) 更早 (16例).
- 结合技术培训和机构支持对于切换到独立实践的外科医生至关重要.
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