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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 79 -83. doi: 10.3877/cma.j.issn.1674-3946.2022.01.023

论著

3D腹腔镜根治性全胃切除术的学习曲线
沈晓菲1, 刘颂1, 夏雪峰1, 康星1, 宋鹏1, 王峰1, 王萌1, 赵阳2, 杜峻峰3, 陆晓峰1,(), 管文贤1,()   
  1. 1. 210008 江苏南京,南京大学医学院附属鼓楼医院胃肠外科
    2. 100101 北京,中国科学院动物研究所膜生物学国家重点实验室
    3. 100853 北京,解放军总医院第一医学中心普通外科医学部3.
  • 收稿日期:2021-12-03 出版日期:2022-02-26
  • 通信作者: 陆晓峰, 管文贤

The learning curve of 3D laparoscopic radical total gastrectomy

Xiaofei Shen1, Song Liu1, Xuefeng Xia1, Xing Kang1, Peng Song1, Feng Wang1, Meng Wang1, Yang Zhao2, Junfeng Du3, Xiaofeng Lu1,(), Wenxian Guan1,()   

  1. 1. Department of gastrointestinal surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Jiangsu Province 210008, China
    2. State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
    3. Medical Department of General Surgery, the 1st Medical Center of PLA General Hospital, Beijing 100853, China
  • Received:2021-12-03 Published:2022-02-26
  • Corresponding author: Xiaofeng Lu, Wenxian Guan
  • Supported by:
    National Natural Science Foundation of China(81970500, 81870393, 81802846)
引用本文:

沈晓菲, 刘颂, 夏雪峰, 康星, 宋鹏, 王峰, 王萌, 赵阳, 杜峻峰, 陆晓峰, 管文贤. 3D腹腔镜根治性全胃切除术的学习曲线[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(01): 79-83.

Xiaofei Shen, Song Liu, Xuefeng Xia, Xing Kang, Peng Song, Feng Wang, Meng Wang, Yang Zhao, Junfeng Du, Xiaofeng Lu, Wenxian Guan. The learning curve of 3D laparoscopic radical total gastrectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(01): 79-83.

目的

探讨3D腹腔镜根治性全胃切除术的学习曲线。

方法

回顾性分析2018年8月至2021年10月由同一组医师完成的100例腹腔镜胃癌根治(全胃切除)手术的临床资料,按照手术先后顺序分为2组(第一阶段35例 vs. 第二阶段65例),应用SPSS 22.0进行统计学分析,围手术期指标包括平均累计手术时间、术后平均住院天数及淋巴结清扫数目等计量资料以(均数±标准差)表示,采用独立t检验;术后并发症发生率及中转开腹率等计数指标比较采用卡方检验。

结果

所有手术患者均由同一组手术医生完成,两组患者在年龄、性别、BMI及ASA评分方面均具有可比性。第一阶段患者平均手术时间为(230.8±50.6)min,显著高于第二阶段手术患者的(174.5±30.9)min(P<0.05);两组患者在预估出血量方面,中位预估出血量分别为200 ml和100 ml,差异具有统计学意义(P<0.05),并且第一阶段患者手术时间曲线呈现明显上坡趋势,而第二阶段患者手术时间曲线呈现下坡趋势。两组患者在中转开腹率、淋巴结清扫数目及术后并发症发生率方面无显著差异。

结论

3D腹腔镜根治性全胃切除术的学习曲线大致为35例,手术者及团队能顺利跨过学习曲线,进行成熟的3D腹腔镜根治性全胃切除术。

Objective

To explore the learning curve of 3D laparoscopic radical total gastrectomy.

Methods

A retrospective analysis on the clinical data of 100 laparoscopic radical gastrectomy(total gastrectomy)performed by the same group of physicians from August 2018 to October 2021 was divided into 2 groups according to the order of operation(35 cases in the firstperiod vs. 65 cases in the second period). SPSS 22.0 was used for statistical analysis. Perioperative indicators,including mean cumulative operation time,mean postoperative hospital stay and number of lymph nodes dissected,were expressed as(mean±standard deviation),and independent T test was used. Chi-square test was used to compare the incidence of postoperative complications and conversion rate to open surgery.

Results

All surgical patients were performed by the same group of surgeons,and the two groups of were comparable in terms of age,gender,BMI and ASA scores. The average operation time of the first period was 230.8±50.6 minutes,which was significantly higher than that of the second stage patients(174.5±30.9)(P<0.05). In terms of estimated bleeding volume,the median estimated bleeding volume was 200 ml and 100 ml,respectively,and the difference was statistically significant(P<0.05). The operation time curve of patients in the first period showed an obvious upward slope,while the operation time curve of patients in the second period showed a downward trend. There was no significant difference in the conversion rate,the number of lymph node dissections,and the incidence of postoperative complications.

Conclusion

The learning curve of 3D laparoscopic radical gastrectomy(total gastrectomy)is roughly 35 cases. The surgeon team can smoothly cross the learning curve and perform mature 3D laparoscopic radical gastrectomy.

表1 100例3D腹腔镜根治性全胃切除术患者中,学习曲线处于第一阶段与第二阶段患者一般基线资料比较[例(%)]
表2 100例3D腹腔镜根治性全胃切除术患者中,学习曲线处于第一阶段与第二阶段患者围手术期资料比较(
xˉ
±s
图1 随着手术例数的增加,手术时间变化趋势图
图2 CUSUM分析显示第一阶段学习曲线呈现上坡趋势
图3 CUSUM分析显示第二阶段随着手术例数增加,学习曲线呈现下坡趋势
[1]
杜峻峰,李世拥. 3D腹腔镜直肠癌根治术的优势及面临的机遇与挑战[J/CD]. 中华普外科手术学杂志(电子版)202014(4):340-342.
[2]
王泽,陈凛. 2D、3D腹腔镜及开放胃癌根治术后并发症特点及发生率的比较[J]. 解放军医学院学报202142(3):301-305.
[3]
王长庆,秦占坤,冉文斌,等. 3D腹腔镜胃癌根治术治疗胃癌效果分析[J]. 山西医药杂志202150(22):3152-3154.
[4]
黄昌明,林建贤. 腹腔镜胃癌根治术淋巴结清扫中团队配合的策略与技巧[J].中华消化外科杂志201918(3):209-212.
[5]
徐东楚,郭云虎,刘永健,等. 3D腹腔镜辅助根治性全胃切除术的临床应用[J].中国现代普通外科进展201821(10):804-805.
[6]
徐泽宽,王林俊,李博文. 腹腔镜胃癌手术进展及展望[J]. 中国实用外科杂志202040(2):185-190.
[7]
Dindo D,,Demartines N,,Clavien PA. Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg2004240(2):205-213.
[8]
Yu J,,Huang C,,Sun Y,et al. Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer:The CLASS-01 Randomized Clinical Trial[J]. JAMA2019321(20):1983-1992.
[9]
Huang C,,Liu H,,Hu Y,et al. Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer:Five-Year Outcomes From the CLASS-01 Randomized Clinical Trial[J]. JAMA Surg2022157(1):9-17.
[10]
杨力,徐泽宽. 腹腔镜全胃切除术后消化道重建的经验与思考[J/CD]. 中华腔镜外科杂志(电子版)201912(4):207-212.
[11]
李国新,刘浩. 胃癌微创外科临床研究进展及展望(2000-2020)[J]. 中国实用外科杂志202040(1):62-64.
[12]
余江,陈新华,李国新. 适应时代需求:开创腹腔镜胃肠外科培训新局面[J].中华消化外科杂志202120(1):75-77.
[13]
陆晓峰,刘颂,艾世超,等. 纳米碳与吲哚菁绿导航腹腔镜胃癌根治术淋巴结清扫的对比性研究[J/CD]. 中华普外科手术学杂志(电子版)202115(2):146-149.
[14]
陆晓峰,刘颂,艾世超,等. 纳米碳导航3D腹腔镜胃癌根治术中淋巴结分拣的临床价值探讨[J/CD]. 中华腔镜外科杂志(电子版)202013(6):352-356.
[15]
季加孚. 胃癌腹腔镜外科的中国标准和里程碑[J]. 中华胃肠外科杂志201922(10):913-915.
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