在中国的高等教育中心,口腔内镜肌肉切除的学习曲线
Liu Simao1,2,3, Chang Hongkai1,2,3, Gu Junnan4
1Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Surgical endoscopy
|December 5, 2025
概括
经验丰富的内镜医生在15-20个病例后就获得了阿喀拉西亚口腔内镜肌切除术 (POEM) 的熟练程度. 这种微创手术在整个学习过程中保持了安全性和有效性,并且在熟练后在医院停留时间更短.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 医学教育 医学教育
背景情况:
- 阿哈拉西亚是一种罕见的食道运动障碍,其特点是受损的下食道关节放松.
- 口腔内镜肌切除术 (POEM) 是一种主要的轻微侵入性治疗 achalasia.
- 定义POEM的学习曲线对于经验丰富的内镜医生广泛采用至关重要.
研究的目的:
- 在经验丰富的内镜医生中确定口腔内镜肌切除术 (POEM) 的学习曲线.
- 评估经验对POEM手术时间,并发症和临床结果的影响.
- 在第三级护理环境中建立POEM熟练程度的基准.
主要方法:
- 以后回顾168个POEM手术由三个内镜医生进行,他们先前有内镜下粘膜切割 (ESD) 经验.
- 分析程序时间的累积和 (CUSUM) 分析,以确定学习曲线的拐点.
- 评估二次结果,包括并发症,住院和三年临床成功 (埃卡德得分≤3).
主要成果:
- 对于POEM的学习曲线,在15-20个案例中显示了拐点,之后程序时间显著减少 (94.9 ± 27.4分钟至55.5 ± 15.5分钟).
- 在学习阶段,并发症率保持稳定 (19.6%对17.1%).
- 熟练程度与较短的住院时间 (6.6±2.0天) 相关,并保持高的3年临床成功率 (95%).
结论:
- 内镜下粘膜切割 (ESD) 专业知识有助于在15-20个案例内实现POEM熟练程度.
- 在整个学习过程中,保证了POEM的安全性和有效性.
- 在熟练阶段较短的住院时间表明,术后管理和程序效率得到了改善.
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