Das Raj, Lucatelli Pierleone, Wang Haofan, Belli Anna-Maria
Department of Radiology, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK,
Cardiovasc Intervent Radiol. 2015 Aug;38(4):871-7. doi: 10.1007/s00270-014-1040-9. Epub 2014 Dec 19.
A clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.
Ten IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to three groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).
Mean fluoroscopy time was 18.4 (± 8.1), 17.3 (± 9.0), 16.3 (± 8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4%.
UAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.
清楚了解操作人员的经验对于提高血管内介入手术的技术成功率并将患者风险降至最低非常重要，而且有必要确保实习生具备作为主要操作人员的适当技能。本研究的目的是回顾性分析在介入放射学（IR）培训单位由IR实习生进行的子宫动脉栓塞术（UAE），分析透视时间和辐射剂量作为技术技能的替代指标。
在5年期间，10名IR住院医师作为主要操作人员进行了200例UAE手术。我们将透视时间、辐射剂量和并发症进行了比较，之后将它们分为三组：第1组，最初的5例；第2组，超过5例手术；第3组，倒数第5例UAE手术。我们记录了可能影响筛查时间的因素（使用的药瓶数量和微导管的使用）。
第1组、第2组和第3组的平均透视时间分别为18.4（±8.1）、17.3（±9.0）、16.3（±8.4）分钟。这些组在透视时间或辐射剂量方面没有统计学上的显著差异（p>0.05）。校正混杂因素后的分析显示无统计学意义（p>0.05）。所有手术在技术上均获成功，总并发症发生率为4%。
UAE被选为IR从业者遵循的高度标准化手术。尽管随着经验增加筛查时间有缩短的不显著趋势，但在适当的顾问监督下，技术成功率和安全性并未受到影响，这说明了IR培训的安全模式。这对于在培训单位接受手术的患者来说是重要且令人安心的信息。
