摘要
目的探讨单孔腹腔镜下腹膜外未闭鞘突结扎术的学习曲线。方法收集2017年10月至2018年4月,河北省保定市儿童医院小儿腹股沟斜疝或鞘膜积液患儿临床资料,均行单孔腹腔镜下双钩疝针辅助腹膜外内环结扎术,分别由6名医师完成,选每名医师的前20例患儿,共计120例患儿手术资料。6名医师根据已从事腹腔镜手术的年资分为A组(>3年)3位,B组(≤3年)3位,以每5例为1个学习曲线段,比较2组病例4个阶段的手术时间,术中增加套管、中转开放手术、术中术后并发症例数。结果 A组第2阶段,即5例后,手术时间明显缩短,B组第3阶段,即10例后,手术时间明显缩短;2组出血量均<2 ml;A组术中增加套管1例,中转开放手术1例,B组术中增加套管2例,中转开放手术1例;A组术中术后各种并发症3例,B组术中术后各种并发症4例,均无复发病例。结论单孔腹腔镜腹膜外内环结扎术学习曲线:有一定腹腔镜基础的医师5例,基础欠丰富的医师15例。技术操作简便、安全、有效,值得临床推广。
Objective To explore the learning curve of single-port laparoscopic ligation of the patent processusvaginalis. Methods From October 2017 to April 2018, clinical data of children with indirect inguinal hernia or hydrocele in Baoding Children＇s Hospital were collected. Single-port laparoscopic extraperitoneal inner ring ligation assisted with double-hook hernia needle was performed by 6 doctors. The first 20 children of each doctor were selected and 120 patients were operated. Six doctors were divided into group A（〉3 years） and group B（≤3 years） according to the seniority of laparoscopic surgery. Each 5 cases was taken as a learning curve stage. The operative time, intraoperative bleeding, the number of increasing trocar or cases of conversion to open surgery, intraoperative and postoperative complications were compared between the two groups. Results In group A, the operation time was significantly shortened at the second stage（after 5 cases）. In group B, the operation time was significantly shortened at the third stage（after 10 cases）. The bleeding loss in both groups was less than 2 ml. 1 case of additional trocar and 1 case of open conversion was occurred in group A, while the number in group B were 2 cases and 1 case, respectively. There were 3 cases and 4 cases of complications after operation in group A and group B, respectively, without recurrence. Conclusion The learning curve of single-port laparoscopic extraperitoneal inner ring ligation is 5 cases for laparoscopic experienced surgeon and 15 cases for beginner. The technology is simple, safe and effective, and is worthy of clinical promotion.
作者
陈海涛
范林林
张旭
刘闯
杨斌
刘风昌
Chen Haitao;Fan Linlin;Zhang Xu;Liu Chuang;Yang Bin;Liu Fengchang(Department of Surgery,Baoding Children＇s Hospital,Hebei 071000,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2018年第5期345-347,共3页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
腹腔镜
单孔
双钩疝针
学习曲线
Laparoscopes
Single port
Two-hooked core needle
Learning curve
