Ye Jiye, Yang Ruiting, Wu Jie, Xu Chunming, Hong Tao
Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Department of Neurosurgery, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, Hubei, China.
Front Surg. 2024 Feb 28;11:1146957. doi: 10.3389/fsurg.2024.1146957. eCollection 2024.
To evaluate the cumulative summation (CUSUM) analysis of the learning curve for Endoscopic Endonasal Transsphenoidal resection of craniopharyngioma (EETC).
Retrospectively analyzed the clinical data of 113 patients who underwent EETC by the same neurosurgery team of the first affiliated Hospital of Nanchang University from June 2012 to November 2020. The learning curve was created by the CUSUM method and analyzed, which was divided into two groups: the learning stage and stable stage based on the learning curve trend. The median operation time and minimum surgical case number was calculated and the operation time and postoperative complications were compared between the two groups.
The median operation time was 318 min. The best fitting curve equation was = 227.72 + 49.06 + 0.14- 0.05, = 0.949, ( < 0.001). The minimum number of surgical cases was 65. Between the two groups, the operation time decreased from 360.8 ± 106.4 min in the learning group to 281.6 ± 69.9 min in the stable group ( < 0.05). The incidence of postoperative complications (intracranial infection, cerebrospinal fluid rhinorrhea, and diabetes insipidus) was significantly reduced ( < 0.05).
The CUSUM learning curve of craniopharyngioma resection via endoscope endonasal transsphenoidal approach could better describe the learning process for a neurosurgeon. The frequency of surgery could be a good factor for strengthening the learning effect and help to shorten the learning time. After 65 cases of EETC, the surgical skills can reach a stable stage, the operation time is obviously shortened, and the postoperative complications are significantly reduced.
评估颅咽管瘤鼻内镜经蝶窦切除术（EETC）学习曲线的累积和（CUSUM）分析。
回顾性分析2012年6月至2020年11月南昌大学第一附属医院同一神经外科团队为113例行EETC患者的临床资料。采用CUSUM方法绘制并分析学习曲线，根据学习曲线趋势将其分为学习阶段和稳定阶段两组。计算中位手术时间和最小手术例数，并比较两组的手术时间和术后并发症。
中位手术时间为318分钟。最佳拟合曲线方程为 = 227.72 + 49.06 + 0.14 - 0.05， = 0.949，（ < 0.001）。最小手术例数为65例。两组间，手术时间从学习组的360.8±106.4分钟降至稳定组的281.6±69.9分钟（ < 0.05）。术后并发症（颅内感染、脑脊液鼻漏和尿崩症）的发生率显著降低（ < 0.05）。
经鼻内镜蝶窦入路切除颅咽管瘤的CUSUM学习曲线能更好地描述神经外科医生的学习过程。手术频率可能是增强学习效果并有助于缩短学习时间的良好因素。65例EETC术后，手术技能可达到稳定阶段，手术时间明显缩短，术后并发症显著减少。
