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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 376 -379. doi: 10.3877/cma.j.issn.1674-3946.2021.04.007

论著

单中心腹腔镜肝部分切除术学习曲线分析
李永宁1, 喻超2, 李英1, 朱昌毫1, 王兴1, 潘耀振1,()   
  1. 1. 550025 贵阳,贵州医科大学
    2. 550004 贵阳,贵州医科大学附属医院
  • 收稿日期:2020-08-11 出版日期:2021-08-17
  • 通信作者: 潘耀振

Learning curve of laparoscopic hepatectomy: a single-center study

Yongning Li1, Chao Yu2, Ying Li1, Changhao Zhu1, Xing Wang1, Yaozhen Pan1,()   

  1. 1. Guizhou Medical University, Guiyang 550025, China
    2. Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
  • Received:2020-08-11 Published:2021-08-17
  • Corresponding author: Yaozhen Pan
  • Supported by:
    Guizhou Science and Technology Plan Project(QKH[2021] General 100); Big Health Cooperation Project of Guiyang Science and Technology Bureau(Zhuke Contract [2019]9-1-35); Guiyang Science and Technology Plan Project(Zhuke Contract[2019]9-1-26;[2018]1-86)
引用本文:

李永宁, 喻超, 李英, 朱昌毫, 王兴, 潘耀振. 单中心腹腔镜肝部分切除术学习曲线分析[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(04): 376-379.

Yongning Li, Chao Yu, Ying Li, Changhao Zhu, Xing Wang, Yaozhen Pan. Learning curve of laparoscopic hepatectomy: a single-center study[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 376-379.

目的

探讨单中心腹腔镜肝部分切除术(LH)的学习曲线。

方法

学习曲线累计求和分析法分析2014年6月至2020年6月完成的118例LH一般资料。采用SPSS 22.0进行统计分析;采用Minitab17.0绘制CUSUM控制图及拟合曲线。当P≤0.05时判断曲线拟合成功,R2值判断拟合优度,R2值越接近1说明拟合度越好。

结果

手术时间累积和拟合曲线公式:CUSUM(n) = 27.86+17.00 n-0.1938 n2+0.000415n2(n为病例数),拟合系数R2=0.963。据拟合曲线分析将118例腹腔镜肝部分切除术的学习曲线划分为三个阶段,早期组(1~36例)、中期组(37~88例)和后期组(89~118例)。后期组在手术时间(P<0.001)、术中出血量(P=0.003)、术后住院时间(P<0.001)均优于其他两组,差异均有统计学意义;在中转开腹率(P=0.336)、术后并发症发生率(P=0.099)方面三组差异无统计学意义。

结论

积和分析法得出LH的学习曲线由三个特征性阶段组成,术者基本掌握LH需累积完成37~88例手术。

Objective

To explore the learning curve of laparoscopic partial hepatectomy (LH) in single-center.

Methods

The general data of 118 cases of LH from June 2014 to June 2020 were analyzed by using learning curve analysis. SPSS 22.0 were used for statistical analysis. Minitab 17.0 was used to draw CUSUM control chart and fitting curve. When P≤0.05, the fitting curve was recognized as successful, and the R2 value was used to judge the goodness of fitting. The closer the R2 value is to 1, the better the goodness of fitting is.

Results

The cumulative operative time and the fitting curve formula: CUSUM(n)=27.86+ 17.00 n-0.1938 n2+ 0.000415 n2(n is the number of cases), the fitting coefficient R2=0.963. According to the fitting curve analysis, the learning curve of laparoscopic partial hepatectomy was divided into three phases: the early phase group (1~36 cases), the middle phase group (37~88 cases) and the late phase group (89~118 cases). The operative time (P<0.001), intraoperative blood loss (P=0.003) and postoperative time of hospitalization (P<0.001) in the late phase group were better than those in the other two phase groups, with statistical significant difference. There were no significant difference in conversion rate (P=0.336) and the incidence of postoperative complications (P=0.099) among the three groups.

Conclusion

Cumulation and analysis show that the learning curve of laparoscopic partial hepatectomy consists of three characteristic phases. The operator basically mastered LH need to complete a cumulative total of 37~88 cases.

表1 118例肝占位行LH手术患者医生学习曲线不同阶段的基线资料[(±s),例]
图1 手术时间累积和控制图
图2 LLR-CUSUM学习曲线拟合图
图3 学习曲线不同时期术中出血量变化
表2 118例肝占位行LH手术患者医生学习曲线不同阶段围术期观察指标[四分位间距(IQR)]
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