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手术经验是否会影响视网膜脱离手术的成功率?

Does surgical experience have an effect on the success of retinal detachment surgery?

机构信息

Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.

出版信息

Retina. 2012 Jan;32(1):32-7. doi: 10.1097/IAE.0B013E3182411CD2.

Abstract

PURPOSE

To examine the relationship between surgeon experience and success rates in retinal detachment surgery.

METHODS

Success rates during a follow-up of 11 months of 8 surgeons who performed in total 375 retinal detachment procedures ranging from 14 to 115 cases between December 1997 and January 2002 were correlated to the total number of vitreoretinal procedures ranging between 176 and 2,587. All patients received either scleral buckling or vitrectomy, and complicated cases were excluded.

RESULTS

Mean primary anatomical success rates were 0.69 ± 0.14 for scleral buckling and 0.9 ± 0.05 for primary vitrectomy (P < 0.05). The primary anatomical success rates did not correlate to the number of vitreoretinal procedures. Seven of the eight surgeons showed an intraindividual learning effect with better success rates in the second versus the first half of the observed procedures. The learning effect was correlated to the total number of procedures with a higher effect in inexperienced surgeons.

CONCLUSION

An intraindividual learning effect that was higher in inexperienced surgeons could be demonstrated. The learning effect was reduced by half after 500 vitreoretinal procedures while the primary anatomical success rates were not correlated to the number of vitreoretinal procedures.

摘要

目的

研究视网膜脱离手术中外科医生经验与成功率之间的关系。

方法

1997 年 12 月至 2002 年 1 月,8 位外科医生共进行了 375 例视网膜脱离手术,随访 11 个月,将他们的成功率与 1997 年 12 月至 2002 年 1 月期间进行的总数在 176 至 2587 例之间的玻璃体视网膜手术总数相关联。所有患者均接受巩膜扣带术或玻璃体切除术,且排除复杂病例。

结果

巩膜扣带术的主要解剖学成功率为 0.69 ± 0.14,玻璃体切除术的主要解剖学成功率为 0.9 ± 0.05(P<0.05)。主要解剖学成功率与玻璃体视网膜手术数量无关。8 位外科医生中有 7 位显示出个体内学习效应,即在观察到的手术的后半段中,成功率更高。学习效应与手术总数相关,在经验不足的外科医生中,效果更高。

结论

可以证明存在个体内学习效应,经验不足的外科医生的学习效应更高。在进行了 500 例玻璃体视网膜手术后,学习效应降低了一半,而主要解剖学成功率与玻璃体视网膜手术数量无关。

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