摘要
目的探讨同一组术者行腹腔镜辅助直肠癌根治术的学习曲线,总结腹腔镜辅助直肠癌手术经验。方法回顾性分析2010年1月至2015年12月期间笔者所在医院科室同一组术者连续开展的119例腹腔镜辅助直肠癌根治术患者的临床资料,对于每一例患者的手术时间,采用加权移动平均法、累及分析法(cumulative sum analysis,CUSUM)、风险调整累及分析法(risk-adjusted CUSUM,RA-CUSUM)以及曲线拟合软件Matlab分析学习曲线;再通过比较学习曲线中每一阶段患者的手术时间、术中出血量、淋巴结检出个数、远端切缘距肿瘤下缘距离、并发症发生情况、术后住院时间以及术后首次进流食时间来验证近期疗效,总结腹腔镜辅助直肠癌的手术经验。结果该组医师行腹腔镜辅助直肠癌手术学习曲线分为3个阶段及2个时间截点,第1个截点是在完成手术第36例左右,第2个截点在完成手术第80例左右。3个阶段患者的一般资料比较其差异无统计学意义(P>0.05),但比较3个阶段患者的手术时间、术中出血量、淋巴结检出个数、远端切缘距肿瘤下缘距离、并发症发生情况和术后住院时间,其差异均有统计学意义(P<0.05),以第3阶段最优,第2阶段次之,第1阶段最差。结论腹腔镜辅助直肠癌根治术学习曲线可分为初步探索期、掌握期和熟练期;有丰富开腹直肠癌手术经验的该组固定手术团队腹腔镜辅助直肠癌手术达到掌握程度完成第1阶段需要36例左右,达到熟练程度完成第2阶段需80例左右,且在学习曲线不同阶段所完成手术的近期疗效有差异。
Objective To investigate the learning curve of laparoscopic assisted rectal cancer radical resection of a surgeon and share the experience of laparoscopic surgery. Methods The date of 119 consecutive patients who were suffered operation by same team during January 2010 to December 2015 were retrospectively analyzed. The learning curve and its stages were obtained by using weighted moving average method, cumulative sum analysis（CUSUM）, risk-adjusted CUSUM （RA-CUSUM）and Matlab software. The effects of each stage, such as operative time, intraoperative bold loss, harvested lymph node numbers, distal margin to the edge of tumor, complications after operation, hospital stay days, and the first time take soft food were compared, and the experience of laparoscopic assisted surgery for rectal cancer was summarized. Results Our learning curve was divided into three periods, the cutting point was around 36^th and 80^th cases, respectively. There was no significant difference between the 3 stages in general data, however when comparing the operative time, loss of blood, harvested lymph node numbers, the distal margin to the edge of tumor, hospital stay and total complications, the last period were best and the first stage were worst. Conclusions The learning curve can be divided into three stages, the exploration, mastery and proficient period. Our term, fixed and with rich experience in laparotomy, completed our first exploration period at about 36^th patients and the second stage is around 80^th cases. And the short term effect of each period’s had gradually improved with master of laparoscopic technique.
出处
《中国普外基础与临床杂志》
CAS
2017年第1期37-42,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
国家自然科学基金项目(项目编号:81101874
81172362)
陕西省科学技术研究发展计划项目(项目编号:2016SF-015
2016SF-157
2015SF053
2015SF037)
陕西省科技统筹创新工程计划项目(项目编号:2013KTCQ03-08)
关键词
腹腔镜
直肠癌
学习曲线
近期疗效
aparoscopic surgery
rectal cancer
learning curve
short-term effect
