Objectives: 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.
Methods: 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.
Results: 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 P<0.05), the operative time in group a was significantly lengthened (all P<0.05), and the radiation dose in group a was significantly increased (all P<0.05).
Conclusions: 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.
目的: 肾上腺静脉采血(adrenal venous sampling，AVS)是公认的鉴别原发性醛固酮增多症的有效手段之一，其成功率与术者的技能掌握程度具有一定相关性。本研究旨在分析AVS的学习曲线，了解术者熟练掌握AVS所需要实践的病例数，为该技术的规范化开展提供借鉴。方法: 回顾性分析2015年8月至2021年2月于中南大学湘雅二医院行连续AVS手术的120例原发性醛固酮增多症患者的临床资料，收集并记录患者的年龄、性别、血压、手术成功率、手术时间、术中辐射剂量及手术相关并发症。采用累积和分析对术者学习曲线进行分析，依据学习曲线确定熟练掌握该手术的最少病例数，并以该界值按照接受AVS的时间先后顺序将患者分为a、b、c、d 4组，比较各组的AVS成功率、辐射剂量、手术时间及并发症发生情况。结果: 累积和分析显示学习曲线可分为学习阶段和熟练阶段，以30例为临界值，术者手术经验由生涩迈向成熟。a、b、c、d组的AVS成功率分别为66.7%、86.7%、93.3%、96.7%，a组手术成功率明显低于其他组(均P<0.05)，手术时间明显长于其他组(均P<0.05)，辐射剂量明显高于其他组(均P<0.05)。结论: 经30例AVS手术经验的积累，原发性醛固酮增多症患者的手术时间明显缩短，辐射剂量明显降低，手术并发症明显减少，术者的学习曲线进入平台期；未来或可通过更进一步的规范化培训提升AVS手术的成功率。.
Keywords: adrenal vein sampling; interventional radiology; learning curve; primary aldosteronism.