Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Department of Otolaryngology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Acta Neurochir (Wien). 2020 Oct;162(10):2361-2370. doi: 10.1007/s00701-020-04471-x. Epub 2020 Jul 1.
Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has become a mainstay of treatment over the last two decades and it is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement.
The objective of this study was to assess the slope of the learning curve over a long period of time for a variety of outcomes measures.
We examined outcomes and complications in a consecutive series of 600 EETS for pituitary adenoma grouped into quartiles based on date of surgery.
GTR significantly increased across quartiles from 55 to 79% in the last quartile (p < 0.005). The rate of intraoperative CSF leak significantly decreased from 60% in the first quartile to 33% in the last quartile and the rate of lumbar drain placement from 28% in the first quartile to 6% in the last quartile (p < 0.005). Hormonal remission for secreting adenomas increased from 68% in the first quartile to 90% in the last quartile (p < 0.05). The rate of post-operative CSF leak trended lower (3% in first quartile to 0.7% in last two quartiles). The greatest improvement in outcome occurred between the first and second quartiles (19.9%), but persistent improvement occurred between the second and third (6.7%) and third and fourth quartiles (8.0%).
Although the slope of the learning curve is steeper earlier in a surgeon's experience, the slope does not plateau and continues to increase even over more than a decade.
经鼻内镜蝶窦入路垂体瘤切除术（EETS）在过去二十年已成为治疗的主要方法，人们普遍认为一旦达到这个学习曲线，就会达到一个平台期，只有很少的增量改进。
本研究的目的是评估各种结果测量的学习曲线的斜率在很长一段时间内的情况。
我们检查了 600 例连续接受 EETS 治疗的垂体瘤患者的结果和并发症，这些患者按手术日期分为 quartiles。
GTR 显著增加，从第一 quartile 的 55%增加到最后一个 quartile 的 79%（p<0.005）。术中脑脊液漏的发生率从第一 quartile 的 60%显著下降到最后一个 quartile的 33%，腰椎引流的发生率从第一 quartile的 28%下降到最后一个 quartile的 6%（p<0.005）。分泌性腺瘤的激素缓解率从第一 quartile的 68%增加到最后一个 quartile的 90%（p<0.05）。术后脑脊液漏的发生率呈下降趋势（第一 quartile为 3%，最后两个 quartile为 0.7%）。结果的最大改善发生在第一和第二 quartile 之间（19.9%），但在第二和第三 quartile 之间（6.7%）和第三和第四 quartile 之间（8.0%）仍持续改善。
尽管在外科医生的经验中，学习曲线的斜率在早期更为陡峭，但即使超过十年，斜率也不会趋于平稳，仍会继续增加。
