结直肠支架置入治疗结直肠恶性梗阻的学习曲线。
The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction.
机构信息
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Gut Liver. 2012 Jul;6(3):328-33. doi: 10.5009/gnl.2012.6.3.328. Epub 2012 May 22.
BACKGROUND/AIMS: We aimed to assess the effectiveness of self-expanding metal stent (SEMS) insertion by evaluating the learning curve in relation to the experience of an endoscopist.
METHODS
We retrospectively analyzed the outcomes of 120 SEMS insertion procedures performed by one endoscopist in patients with malignant colorectal obstruction. We compared the technical and clinical success rates, complication rates, and duration of the procedures by quartiles.
RESULTS
The mean age of the patients (76 men and 44 women) was 64.6 years. The overall technical success rate was 95.0% (114/120), and the clinical success rate was 90.0% (108/120). The median procedure duration was 16.2 minutes (range, 3.4 to 96.5 minutes). From the first to the last quartile, the technical success rates were 90.0%, 96.7%, 96.7%, and 96.7% (p=0.263), and the clinical success rates were 90.0%, 90.0%, 96.7%, and 83.3% (p=0.588), respectively. Procedure-related complications were observed in 28 patients (23.3%). The complication rates for SEMS insertion when patients were divided by quartiles were 26.7%, 23.3%, 10.0%, and 33.3% (p=0.184), respectively. Moreover, the number of stents per procedure was 1.13, 1.03, 1.00, and 1.00 (p=0.029), respectively. The median duration of SEMS insertion decreased significantly, 20.9 to 14.8 minutes after the first 30 procedures (p=0.005).
CONCLUSIONS
An experienced endoscopist was able to perform the SEMS insertion procedure easily and effectively after performing 30 SEMS insertions.
背景/目的：我们旨在通过评估内镜医生的经验与学习曲线的关系来评估自膨式金属支架（SEMS）置入的效果。
方法
我们回顾性分析了一位内镜医生对 120 例因恶性结直肠梗阻而行 SEMS 置入术的患者的治疗结果。我们通过四分位数比较了技术和临床成功率、并发症发生率和操作持续时间。
结果
患者的平均年龄（76 名男性和 44 名女性）为 64.6 岁。总体技术成功率为 95.0%（114/120），临床成功率为 90.0%（108/120）。操作的中位数持续时间为 16.2 分钟（范围 3.4 至 96.5 分钟）。从第一四分位数到最后一个四分位数，技术成功率分别为 90.0%、96.7%、96.7%和 96.7%（p=0.263），临床成功率分别为 90.0%、90.0%、96.7%和 83.3%（p=0.588）。28 例患者（23.3%）出现了与操作相关的并发症。当根据四分位数将患者分为 SEMS 置入组时，并发症发生率分别为 26.7%、23.3%、10.0%和 33.3%（p=0.184）。此外，每个操作置入的支架数量分别为 1.13、1.03、1.00 和 1.00（p=0.029）。在完成前 30 例操作后，SEMS 置入的中位时间显著缩短，从 20.9 分钟缩短至 14.8 分钟（p=0.005）。
结论
经验丰富的内镜医生在完成 30 例 SEMS 置入术后，能够轻松有效地进行 SEMS 置入术。
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