分析超声介入医师行实时影像虚拟导航系统（RVS）辅助肝癌消融的学习曲线。

回顾性分析2018年10月至2019年9月就诊于浙江中医药大学附属杭州市西溪医院的，由同一名具有5年以上超声引导下肝癌消融经验的医师，行RVS引导下辅助肝癌消融的第1~60例肝癌患者资料。按照治疗顺序分为A、B、C组，每组各20例。采用方差分析比较各组间RVS术前融合时间和肿瘤消融时间的差异，组间两两比较采用LSD-t检验；采用Fisher确切概率法分析患者组间肿瘤1次性消融成功率和术后1个月肿瘤的完全灭活率的差异。绘制RVS辅助肝癌消融的术前融合时间曲线图。

A组的RVS术前融合时间、肿瘤消融时间明显大于B组及C组［（20.9±6.7）min vs （9.7±1.2）min vs （9.6±2.7）min；（23.1±7.9）min vs （19.6±5.0）min vs （19.2±3.7）min］，差异具有统计学意义（t=7.4，P＜0.001；t=1.9，P=0.035），B组与C组之间比较，差异均无统计学意义（P均＞0.05）；A组的肿瘤1次性消融成功率［74.1%（20/27）］小于B组［96.4%（27/28）］和C组［96.4%（27/28）］，差异具有统计学意义（P均=0.025），B组与C组之间比较，差异无统计学意义（P＞0.05）。3组RVS辅助肝癌消融术后1个月肿瘤完全灭活率比较［92.6%（25/27） vs 92.9%（26/28） vs 92.9%（26/28）］，差异均无统计学意义（P均＞0.05）。操作者积累约20例患者后，术前融合时间趋于稳定，学习进入平台期。

对于期望熟练掌握RVS辅助肝癌消融的介入医师，操作者积累约20例患者RVS辅助肝癌消融可以明显缩短术前融合时间和肿瘤消融时间，提高融合精准度、团队契合度及肿瘤1次性消融成功率，之后学习曲线进入平台期。

To analyze the learning curve of hepatocellular carcinoma ablation assisted by a real-time image virtual navigation system (RVS).

Sixty patients with hepatocellular carcinoma who underwent tumor ablation assisted by a RVS by the same physician, who had 5 years of experience in ablation, at Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medicine University from October 2018 to September 2019 were analyzed retrospectively. According to the treatment order, the patients were divided into groups A, B, and C, with 20 cases in each group. The difference in preoperative RVS fusion time and tumor ablation time among groups was compared by ANOVA, and pairwise comparisons between groups were performed by LSD-t test; Fisher's exact probability method was used to analyze the difference in the success rate of one-time tumor ablation and the complete tumor inactivation rate one month after surgery between the patient groups. RVS preopreative fusion time curve was plotted to assist liver cancer ablation.

The preoperative fusion time and tumor ablation time of RVS in group A were significantly longer than that in group B and group C [(20.9±6.7) min vs (9.7±1.2) min vs (9.6±2.7) min, t=7.4, P＜0.001; (23.1±7.9) min vs (19.6±5.0) min vs (19.2±3.7) min, t=1.9, P=0.035]); there were no statistically significant difference between group B and group C (P＞0.05). The success rate of one-time tumor ablation in group A [74.1% (20/27)] was significantly lower than those of group B [96.4% (27/28)] and group C [96.4% (27/28)] (P=0.025), although there was no statistically significant difference between group B and group C (P＞0.05). There was no significant difference in the complete tumor inactivation rate one month after tumor ablation among the three groups [92.6% (25/27) vs 92.9% (26/28) vs 92.9% (26/28), P＞0.05]. After the operator accumulated about 20 patients, the pre-operative fusion time tended to stabilize and the learning entered the platform period.

For interventional physicians who are expected to be proficient in hepatocellular carcinoma ablation assisted by a RVS, the accumulated number of patients treated by the operator is about 20, in order to significantly shorten the preoperative fusion time and tumor ablation time, improve the fusion accuracy, team fit, and the success rate of one-time tumor ablation, and make the learning curve enter the plateau stage.