【摘要】 目的 回顾性分析低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术是否存在学习曲线，计算曲线转折点，分析影响学习曲线的其他因素。方法 低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术的患者49例为研究组，以累积和分析法绘制学习曲线，计算转折点，将研究组数据分为学习探索阶段和熟练掌握阶段，比较两组数据各指标差异有无统计学意义；选择同一时期熟练超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术的患者548例为基准组，比较研究组与基准组各指标差异是否有统计学意义；利用线性回归法分别对研究组及基准组中手术时间与其他各指标间的关系进行分析。结果 研究组最佳学习曲线为二次拟合方程，学习曲线转折点为第19例；学习探索阶段和熟练掌握阶段手术时间及BI-RADS分类组间比较差异有统计学意义，其他指标无统计学意义；研究组与基准组手术时间组间比较差异有统计学意义，其他指标无统计学意义；研究组手术时间与结节厚径呈正相关；基准组手术时间与结节长径、厚径及深度呈正相关，与患者年龄呈负相关。结论 低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术存在学习曲线，曲线转折点最佳为第19例，患者年龄、结节长径、厚径及距表皮的深度可能是影响学习曲线的其他因素。更多还原

【Abstract】 Objective To analyze the learning curve of VAB operated by the combination of new ultrasound doctors and skilled clinicians under the guidance of ultrasound, calculate the turning point of curve and analyze other factors affecting the operation time or turning point. Methods A total of 49 patients with ultrasound-guided VAB operated by the combination of new ultrasound doctors and skilled clinicians were selected as the study group. The learning curve was drawn and the turning point of the learning curve was calculated by the cumulative sum analysis method. The data of the study group were divided into the learning exploration stage and the proficiency stage. The differences of each index between the two groups were compared; 548 patients with VAB operated by the combination of skilled ultrasound doctors and skilled clinicians were selected as comparison. The differences between the two groups were compared. The relationship between the operation time and other indexes in the study group and the comparison was analyzed by linear regression method. Results The best learning curve of the study group was quadratic fitting equation, and the turning point of learning curve was 19 cases; There were significant differences only in operation time and BI-RADS classification between the learning exploration stage and the proficiency stage; The difference of operation time between the study group and the comparison was statistically significant, but not in the other index; The operation time of study grop was positively correlated with the tubercle thickness diameter, and there was no correlation with other indexes; The operation time of comparison were positively correlated with the length, thickness and depth of the nodule, and negatively correlated with the age of the patients. Conclusions There is a learning curve in VAB under the combined guidance of new ultrasound doctors and skilled clinicians. The best turning point of the curve is the 19 th case. The patient’s age, nodule length and diameter, thickness and depth from the body surface may be other factors affecting the learning curve.更多还原