Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410008.
Department of Radiology, Anhua People's Hospital, Yiyang Hunan 413500, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021;46(9):996-1002. doi: 10.11817/j.issn.1672-7347.2021.210181.
Adrenal venous sampling (AVS) is one of the recognized effective methods for the identification of primary aldosteronism, and the success rate is related to the skill level of the operator. This study aims to analyze the learning curve of AVS and to determine the number of staged cases of AVS procedure success rate, and to provide a reference for the standardized use of AVS.
The age, gender, blood pressure, surgery success rate, operation time, radiation dose, and operation-related complications of 120 patients with primary aldosteronism who underwent continuous AVS in the Second Xiangya Hospital from August 2015 to February 2021 were retrospectively collected. The cumulative sum analysis was used to analyze the learning curve of the operator. The minimum cases who were proficient in the operation was determined according to the learning curve, and the patients were divided into 4 groups a, b, c, and d according to the time sequence of receiving AVS based on the cut-off point. The AVS success rate, radiation dose, operation time, and complications of each group were analyzed.
The cumulative sum analysis showed that the learning curves were divided into a learning stage and a mastery stage with 30 cases as the cut-off point, and the operation experience of the surgeon was from raw to mature. The success rates of the a, b, c, and d groups were 66.7%, 86.7%, 93.3%, and 96.7%, respectively. Compared with b, c, and d groups, the success rate in group a was significant decreased (all <0.05), the operative time in group a was significantly lengthened (all <0.05), and the radiation dose in group a was significantly increased (all <0.05).
After accumulating the AVS experience of 30 cases of primary aldosteronism, the operation time is obviously shortened, the radiation dose is significantly decreased, the operative complications are significantly reduced, and the learning curve enters a plateau. In the future, the success rate of AVS procedure may be improved through further standardized training.
肾上腺静脉采样（AVS）是原发性醛固酮增多症的一种公认的有效诊断方法，其成功率与操作者的技术水平有关。本研究旨在分析 AVS 的学习曲线，并确定 AVS 操作成功率的分期病例数，为 AVS 的规范化应用提供参考。
回顾性收集 2015 年 8 月至 2021 年 2 月在湘雅二医院连续接受 AVS 的 120 例原发性醛固酮增多症患者的年龄、性别、血压、手术成功率、手术时间、辐射剂量和与手术相关的并发症。采用累积和分析方法对操作者的学习曲线进行分析。根据学习曲线确定熟练操作的最低病例数，并根据截止值将患者分为 4 组 a、b、c 和 d，根据接受 AVS 的时间顺序进行分组。分析每组的 AVS 成功率、辐射剂量、手术时间和并发症。
累积和分析显示，学习曲线分为学习阶段和掌握阶段，以 30 例为截止点，外科医生的手术经验从生到熟。a、b、c 和 d 组的成功率分别为 66.7%、86.7%、93.3%和 96.7%。与 b、c 和 d 组相比，a 组的成功率显著降低（均<0.05），a 组的手术时间明显延长（均<0.05），a 组的辐射剂量明显增加（均<0.05）。
积累 30 例原发性醛固酮增多症的 AVS 经验后，手术时间明显缩短，辐射剂量明显降低，手术并发症明显减少，学习曲线进入平台期。未来，通过进一步的规范化培训，可能会提高 AVS 手术的成功率。
