宫腔镜黏膜下子宫肌瘤切除术的学习曲线分析

目的利用预测分析模型拟合宫腔镜黏膜下子宫肌瘤切除术的学习曲线，为基层医院开展宫腔镜下黏膜下子宫肌瘤切除术的学习过程提供参考。方法收集66例行宫腔镜下黏膜下子宫肌瘤切除术病人，按照手术时间前后顺序进行编号，通过移动平均法分别根据术中出血量、手术时间拟合学习曲线，将病人分为第一阶段组(第1~20例，A组)和第二阶段组(第21~66例，B组)，比较2组病人手术相关指标。结果A组病人手术时间、术中出血量、住院时间均大于B组(P < 0.05~P < 0.01)，2组术后并发症发生情况差异无统计学意义(P>0.05)。2组病人术后月经恢复时间、月经量和术后1个月血红蛋白水平及术后随访妊娠结局差异均无统计学意义(P>0.05)。结论经过前20例宫腔镜黏膜下子宫肌瘤切除术学习阶段后，手术操作相对稳定，宫腔镜黏膜下子宫肌瘤切除术初学者应在前20例手术中严格把握适应证，熟练手术操作，学习处理突发情况，以更好地掌握手术技术。

Learning curve analysis of hysteroscopic submucosal myomectomy

ObjectiveTo use the predictive analysis model to match the learning curve of hysteroscopic submucosal myomectomy, and provide a reference for learning the process of hysteroscopic submucosal myomectomy in primary hospitals.MethodsClinical data of 66 cases who underwent hysteroscopic submucosal myomectomy was selected.The patients were numbered according to the sequence of the operation time, and the learning curve was plotted according to the intraoperative blood loss and the operation time by the moving average method.The patients were divided into the first stage group (1-20 cases, group A) and the second stage group (21-66 cases, group B), and the operation related indicators of the patients in the two groups were compared.ResultsThe operation time, intraoperative blood loss and hospitalization time of patients in group A were greater than those in group B (P < 0.05 to P < 0.01), and there was no significant difference in postoperative complications between the two groups (P>0.05).There was no significant difference in the recovery time of menstruation, the amount of menstruation, the hemoglobin level in the first month after operation and the pregnancy outcome after follow-up between the two groups(P>0.05).ConclusionsAfter the learning stage of 20 surgeries, the surgical technique is relatively stable for beginners in hysteroscopic submucosal myomectomy.Beginners need to strictly grasp the indications in the first 20 surgeries, master the operation, quickly deal with emergencies, in order to better fully master the technology.