摘要
目的比较胸外侧入路和腋窝入路单孔腔镜乳房皮下腺体切除术的扶镜效果及学习曲线。方法制定胸外侧入路和腋窝入路腔镜乳房皮下腺体切除术的场景化扶镜流程,回顾性分析2022年1月至2024年8月于中山大学附属第六医院接受胸外侧入路和腋窝入路行腔镜乳房皮下腺体切除术的75例病人的临床资料。按手术入路不同分为胸外侧入路组(30例)和腋窝入路组(45例),比较两组手术时间、术中出血量、扶镜评价及学习曲线。结果75例病人均于单孔腔镜下完成手术,无中转开放手术。胸外侧入路组手术时间较腋窝入路组显著缩短[(83.97±10.02)min vs.(89.69±11.75)min,P=0.027],术中出血量、术后住院时间及术后并发症发生率差异无统计学意义(P>0.05)。两组腔镜助手技能的结构化评估(SALAS)评分比较结果显示,胸外侧入路组术者发出口头命令项分值高于腋窝入路组,差异有统计学意义[(4.27±0.89)分vs.(3.58±1.45)分,P=0.026],两组操作视野居中、视野与操作区域保持水平、器械的可视化、术者需要自行调整镜头位置及SALAS总分,差异均无统计学意义(P>0.05)。胸外侧入路组和腋窝入路组扶镜手分别于第10、15例手术跨越学习曲线。结论胸外侧入路和腋窝入路腔镜乳房皮下腺体切除术应用场景化扶镜流程,胸外侧入路有利于缩短手术时间,减少扶镜手的学习曲线。
Objective To compare the camera assistance effect and learning curve of single-port endoscopic subcutaneous mastectomy through the lateral chest wall approach and axillary approach.Methods Develop a scene-guided camera assisted endoscopic breast subcutaneous resection procedure for lateral chest wall and axillary approach,and conduct a retrospective analysis of the clinical data from 75 patients who underwent this procedure at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and August 2024.The patients were categorized into two groups based on their surgical approach:the lateral chest wall group(30 cases)and the axillary approach group(45 cases).A comparison was conducted between the two groups in terms of operation time,intraoperative blood loss,camera assistance evaluation,and learning curve.Results The surgeries of 75 patients were all completed under single-port endoscopic surgery without conversion to open surgery.The surgical time for the lateral chest wall approach group was significantly shorter than that of the axillary approach group[(83.97±10.02)min vs.(89.69±11.75)min,P=0.027],while there were no statistically significant differences in intraoperative blood loss,postoperative hospital stay,and postoperative complications(P>0.05).The structured assessment of laparoscopic assistant skills(SALAS)scores showed that the verbal command item score for the lateral chest wall approach group was higher than that of the axillary approach group,with a statistically significant difference[(4.27±0.89)points vs.(3.58±1.45)points,P=0.026].However,there were no statistically significant differences in centering the operating field of view,maintaining a horizontal alignment between the field of view and the operating area,and visualization of instruments between the two groups as well as in adjusting the camera position by the surgeon and SALAS total score(P>0.05).The lateral chest wall approach group and the axillary approach group of assisting surgeons reached a learning turning point
作者
李宗晏
李海燕
LI Zong-yan;LI Hai-yan(Department of General Surgery(Breast Surgery),the Sixth Affiliated Hospital,Sun Yat-sen University,Biomedical Innovation Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2024年第11期1286-1290,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金青年项目(No.81602331)
广东省自然科学基金项目(No.2020A1515010424)。
关键词
单孔腔镜
胸外侧入路
腋窝入路
扶镜技巧
single-port endoscope
lateral chest wall approach
axillary approach
camera-assisted technique
