Jing Xiang, Zhou Yan, Ding Jianmin, Wang Yijun, Qin Zhengyi, Wang Yandong, Zhou Hongyu
Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.
Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China.
Front Oncol. 2020 Oct 20;10:540239. doi: 10.3389/fonc.2020.540239. eCollection 2020.
This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the high-risk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous thermal ablation for liver cancer can be classified into three stages. The major complication rate for tumors in difficult locations were higher than that for all tumors. Handing-down teaching can make an operator arrive at the third stage earlier but not the second stage.
本研究旨在探索实现肝癌热消融（包括困难部位肿瘤）熟练操作所需的特殊努力，并阐明传承式教学对相应过程的影响。分析了接受经皮肝癌热消融患者的主要并发症。采用多项式拟合描述主要并发症发生率与特殊经验之间的关系。分别绘制了全组和每位操作者主要并发症的学习曲线。对困难部位的肿瘤进行了进一步研究。本研究共纳入4363次热消融治疗。4363例患者中有143例发生主要并发症，发生率为3.27%。对困难部位肿瘤进行了806次热消融治疗。这些治疗的主要并发症发生率为6.33%。根据4363例患者学习曲线的趋势，全组经验可分为五个阶段，即高风险期、相对稳定期、不稳定期、熟练期和稳定期。个体操作者的学习曲线可分为高风险期、熟练期和稳定期。该组按时间顺序排列的第一、第二和第三位操作者的主要并发症发生率分别为3.23%、3.35%和3.31%。三位操作者分别绕过第一阶段所需的特殊经验对应410次、510次和440次治疗，绕过第二阶段分别为1850次、850次和870次治疗。三位操作者对困难部位肿瘤治疗的主要并发症发生率分别为7.04%、5.53%和5.98%。对于困难部位的肿瘤，三位操作者分别绕过第一阶段所需的特殊经验对应150次、130次和140次治疗，绕过第二阶段分别为290次、175次和185次治疗。总之，操作者经皮肝癌热消融的学习过程可分为三个阶段。困难部位肿瘤的主要并发症发生率高于所有肿瘤。传承式教学可使操作者更早达到第三阶段，但不能使其达到第二阶段。
