内镜黏膜下剥离术切除早期结直肠肿瘤的学习曲线：应用累积和法。
Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method.
机构信息
Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.
Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
出版信息
Scand J Gastroenterol. 2020 Oct;55(10):1234-1242. doi: 10.1080/00365521.2020.1807597. Epub 2020 Aug 27.
OBJECTIVE
Although scissor-type knives such as the Stag-Beetle (SB) Knife Jr are expected to result in a safe and easy colorectal endoscopic submucosal dissection (CR-ESD), information regarding the learning curve is lacking. Therefore, this study evaluated the learning curve with using SB Knife Jr.
MATERIALS AND METHODS
We retrospectively reviewed 507 CR-ESD procedures performed in 464 patients using SB Knife Jr. The primary endpoint was a learning curve to achieve a satisfactory complete resection rate. The secondary endpoints were learning curves to achieve a satisfactory resection rate, curative resection rate, and resection speed.
RESULTS
The complete, , and curative resection rates were 91.9%, 95.9%, and 84.0%, respectively. Moving average analysis showed that 39 cases were required for a complete resection rate of >80%, 41 for an resection rate of >90%, and 50 for a curative resection rate of >75%. We divided the procedure into three phases using the cumulative sum method: I, II, and III (cases 1-36, 37-119, and 120-507, respectively). Although we found no significant between-phase differences, the complete resection rate showed an increasing trend in Phase III (83.3 vs. 89.2 vs. 93.3%; = .099). The resection rate (91.7 vs. 91.6 vs. 97.2%; = .047) and resection speed (20.5 vs. 7.2 vs. 6.8 min/cm; < .001) were greater in Phase III. Despite the larger specimen size (27.3 vs. 38.2 vs. 40.4 mm; < .001) and more severe fibrosis ( < .001) in Phase III, the procedure time was shorter (73.8 vs. 57.8 vs. 54.2 min; = .041). The curative resection rate was not significantly different between phases.
CONCLUSIONS
SB Knife Jr enables safe and easy CR-ESD during the introductory period compared to the conventional tip-type knife and has an acceptable learning curve. Therefore, using this knife will encourage the widespread adoption of CR-ESD in Asian general hospitals and non-Asian countries.
目的
尽管诸如 Stag-Beetle（SB）Knife Jr 等剪刀式刀被认为可以安全且轻松地进行结直肠内镜黏膜下剥离术（CR-ESD），但有关学习曲线的信息仍有所欠缺。因此，本研究旨在评估使用 SB Knife Jr 的学习曲线。
材料与方法
我们回顾性分析了使用 SB Knife Jr 为 464 例患者实施的 507 例 CR-ESD 手术。主要终点是达到满意的完全切除率的学习曲线。次要终点是达到满意的切除率、治愈性切除率和切除速度的学习曲线。
结果
完全切除率、 切除率和治愈性切除率分别为 91.9%、95.9%和 84.0%。移动平均分析显示，需要 39 例才能使完全切除率>80%，41 例才能使 切除率>90%，50 例才能使治愈性切除率>75%。我们使用累积和法将手术分为三个阶段：I 期、II 期和 III 期（病例数分别为 1-36、37-119 和 120-507）。尽管我们没有发现各阶段之间有显著差异，但 III 期的完全切除率呈上升趋势（83.3%比 89.2%比 93.3%； =.099）。 切除率（91.7%比 91.6%比 97.2%； =.047）和切除速度（20.5 比 7.2 比 6.8 min/cm； <.001）在 III 期更大。尽管 III 期的标本尺寸较大（27.3 比 38.2 比 40.4 mm； <.001）和纤维化更严重（ <.001），但手术时间更短（73.8 比 57.8 比 54.2 min； =.041）。各阶段的治愈性切除率无显著差异。
结论
与传统尖端型刀相比，SB Knife Jr 在介绍期内可安全且轻松地进行 CR-ESD，且具有可接受的学习曲线。因此，使用这种刀将鼓励亚洲普通医院和非亚洲国家广泛采用 CR-ESD。
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