探讨3D腹腔镜根治性全胃切除术的学习曲线。

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。

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。

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。

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

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.

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.

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.