Learning curve and key procedures analysis of modified rat models of orthotopic left lung transplantation
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摘要:
目的 总结和解析大鼠左肺原位肺移植改良模型的关键步骤,为大鼠肺移植模型的建立提供更多经验。 方法 两名术者(术者A、B)分别连续做完整移植手术15例,并将每5例手术分为1个练习阶段。详细记录各移植程序的操作时间,计算总体成功率和1周存活率在不同练习阶段之间的差异,并采用累积和法构建学习曲线。 结果 术者A、B首次移植成功的手术次数分别为第5次、第6次,移植总体成功率分别为80%和87%,大鼠1周存活率均为92%。随着手术例数的增加,两名术者的心肺整体获取、套管制备、冷缺血、热缺血、移植和总手术时间均呈下降趋势(均为P < 0.05)。术者A、B分别有3只、2只大鼠因麻醉过度导致心力衰竭死亡,各有1只大鼠分别于术后1 d、7 d死亡,死因分别为静脉扭曲和肺不张。累积和法拟合优度R2分别为0.992 8和0.976 6,两名术者分别于第7例和第8例移植手术时达到学习曲线拐点。 结论 本课题组改良的大鼠左肺原位肺移植模型在理论和技术上均具有良好的可操作性和可重复性,且具有学习曲线短、手术时间短、受体存活率高且并发症少的优点,在肺移植基础研究领域值得进一步推广和应用。 Abstract:Objective To summarize and analyze the key procedures of the modified rat model of orthotopic left lung transplantation, aiming to provide more experience for the establishment of rat models of lung transplantation. Methods Two surgeons (A and B) performed complete transplantation in consecutive 15 rat models, and every 5 surgeries were divided into 1 practice stage. The operating time of each transplantation procedure was recorded. The differences of overall success rate and 1-week survival rate were calculated among different practice stages. The learning curve was delineated by the cumulative sum method. Results For surgeons A and B, the number of the first successful transplantation was the 5th and 6th time, the overall success rates of transplantation were 80% and 87% respectively, and the 1-week survival rates of rats both were 92%. Along with the increasing number of surgeries, the entire cardiopulmonary procurement, cannula preparation, cold ischemia, warm ischemia, transplantation and total operation time by two surgeons showed a significantly downward trend (all P < 0.05). For surgeons A and B, 3 and 2 rats died of heart failure due to overdose anesthesia, and 1 rat died of vein distortion at postoperative 1 d and 1 died of atelectasis at postoperative 7 d, respectively. The goodness of fit (R2) of cumulative sum method was 0.992 8 and 0.976 6. The turning point of learning curve was achieved in the 7th and 8th transplantation for surgeons A and B. Conclusions The modified rat model of orthotopic left lung transplantation yields high operability and repeatability both theoretically and technologically, and has multiple advantages of short learning curve, short operation time, high survival rate of the recipients and few complications, which is worthy of application in the basic research of lung transplantation. -
表 1 两名术者肺移植各阶段操作时间
Table 1. The operating time of each stage of lung transplantation from two surgeons (x±s, min)
移植程序时间 术者A 术者B 阶段Ⅰ 阶段Ⅱ 阶段Ⅲ P值 阶段Ⅰ 阶段Ⅱ 阶段Ⅲ P值 心肺整体获取时间 11.4±1.8 10.6±1.4 8.8±0.7 a 0.006 16.9±1.6 16.0±0.8 12.2±1.7 a, b < 0.001 套管制备时间 23.5±5.9 25.1±2.8 17.8±3.1 a, b 0.038 48.9±2.1 39.2±7.3 a 22.4±6.2 a, b < 0.001 冷缺血时间 52.9±8.8 51.7±2.8 43.7±2.6 a, b 0.017 84.9±1.2 69.9±12.7 a 43.8±3.4 a, b < 0.001 热缺血时间 41.2±11.3 23.6±7.5 a 13.1±3.5 a < 0.001 34.1±2.0 33.0±7.0 21.3±11.1 a, b 0.039 移植时间 73.2±8.5 53.0±6.2 a 42.2±3.0 a, b < 0.001 74.0±2.1 66.9±11.4 44.2±11.3 a, b 0.001 总手术时间 108.8±10.8 88.8±9.0 a 68.7±4.5 a, b < 0.001 139.8±4.3 122.1±14.1 a 80.7±14.2 a, b < 0.001 注:与阶段Ⅰ比较,aP < 0.05/3;与阶段Ⅱ比较,bP < 0.05/3。 -
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