摘要
目的探究腹腔镜辅助直肠癌经肛全直肠系膜切除术的学习曲线,以期为临床开展该术式提供参考。方法纳入于笔者中心接受腹腔镜辅助经肛全直肠系膜切除术的118例直肠癌患者的临床资料进行回顾性分析。采用累积和分析法绘制手术时间学习曲线,探究度过手术时间学习曲线所需的最少手术例数。采用风险调整累积和分析法绘制手术技术学习曲线,探究进入该术式技术熟练掌握阶段所需的最少手术例数并进行临床资料分析,比较处于该术式技术学习熟悉阶段(A组)和进入该术式技术熟练掌握阶段(B组)的患者的一般资料和围术期资料。其中,一般资料包括年龄、性别、身体质量指数情况、肛提肌夹角情况、肿瘤最大径、肿瘤下缘距肛缘距离、肿瘤T分期,围术期资料包括手术时间、术中出血量、淋巴结检出数目、吻合口漏发生率、Clavien-DindoⅠ~Ⅲ级术后并发症的发生情况。结果累积和分析结果显示度过腹腔镜辅助直肠癌经肛全直肠系膜切除术手术时间学习曲线所需的最少手术例数为84例。风险调整累积和分析结果显示进入腹腔镜辅助直肠癌经肛全直肠系膜切除术技术熟练掌握阶段所需的最少手术例数为42例,将患者分为A组(n=42)与B组(n=76)。两组年龄、身体质量指数情况、肛提肌夹角情况、肿瘤最大径、肿瘤下缘距肛缘距离、肿瘤T分期比较差异无统计学意义(P>0.05);A组男性患者比例低于B组,差异有统计学意义(P<0.05)。A组手术时间长于B组,术中出血量多于B组,差异有统计学意义(P<0.05)。两组淋巴结检出数目、吻合口漏发生率比较差异无统计学意义(P>0.05)。A组出现Clavien-DindoⅠ级、Ⅱ级、Ⅲ级术后并发症的例数分别为7例、3例、4例,B组的相应例数分别为7例、3例、0例。结论累积和分析结果显示度过腹腔镜辅助直肠癌经肛全直肠系膜切除术手术时间学习曲线
Objectives To evaluate the learning curve of laparoscopic-assisted transanal total mesorectal excision(LAtaTME)for rectal cancer and provide reference for clinical practice of this procedure.Methods The clinical data of 118 patients with rectal cancer who underwent LA-taTME were retrospectively analyzed.The learning curve of operative time of LA-taTME was drawn by cumulative summation(CUSUM)method,and the minimum number of operation to cross this learning curve was analyzed.The learning curve of operative technique of LA-taTME was drawn by risk-adjusted cumulative summation(RA-CUSUM)method,and the minimum number of operation to master this operative technique was analyzed.Additionally,the clinical data was analyzed and the general information and perioperative data was compared between the group A(at the phase of learning and familiarizing with operative technique)and the group B(entered the proficient stage).We focused on the general information about age,gender,distribution of different body mass indices,distribution of different angles of levator ani muscle,maximum tumor diameter,distance from lower tumor margin to anal margin and tumor T stage,and perioperative data of operation time,intraoperative blood loss,number of lymph nodes harvested,incidence of anastomotic leakage,and postoperative complications of Clavien-Dindo gradeⅠ-Ⅲwere collected.Results Eighty-four cases of operation was the minimum number to cross the learning curve of operative time of LA-taTME for rectal cancer by CUSUM method.Forty-two cases of operation was the minimum number to enter the proficient stage of operative technique of LA-taTME for rectal cancer by RA-CUSUM method.The patients were divided into the group A and the group B,with 42 cases and 76 cases,respectively.The age,distribution of different body mass indices,distribution of different angles of levator ani muscle,maximum tumor diameter,distance from lower tumor margin to anal margin and tumor T stage were comparable between the group A and the group B(P>0.05),while the p
作者
阚诗轩
张煜
徐朔
张宏
Kan Shixuan;Zhang Yu;Xu Shuo;Zhang Hong(Division of Colorectal Oncology Surgery,Department of General Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,Liaoning,China)
出处
《结直肠肛门外科》
2024年第5期584-588,共5页
Journal of Colorectal & Anal Surgery
