单中心腹腔镜胰体尾切除术学习曲线分析

Analysis of learning curve of laparoscopic distal pancreatectomy in a tertiary hospital

目的:分析并比较单中心不同术者开展腹腔镜胰体尾切除术的学习曲线。方法:收集2016年1月1日至2018年6月1日两位主刀医生收治的共80例行腹腔镜胰体尾切除术患者的临床资料,分别以第10例、15例、20例、25例为节点,分析两位术者在各节点前后患者的基本资料、手术时间、出血量、中转开腹率及术后并发症。结果:术者A团队完成44例,B团队完成36例。术者A学习曲线节点为15例,表现为慢性胰腺炎患者比例增加(0vs.24.14%,P=0.038),而手术时间、术中出血量、B/C级胰瘘发生率差异无统计学意义。术者B学习曲线转折点为10例,表现为中转开腹率降低(50%vs.3.8%,P=0.003)及手术时间缩短[236.00min(191.30-288.30)minvs.168.00min(142.50-219.30)min,P=0.008],而术中出血量、术后并发症发生率差异无统计学意义。结论:即使同一中心的不同术者,其腹腔镜胰体尾切除术学习曲线也不相同,腹腔镜胰体尾切除术学习曲线的分析应个体化。

Objective:To compare the learning curve of laparoscopic distal pancreatectomy performed by different operators in a tertiary hospital.Methods:Clinical data of 80 patients who underwent laparoscopic distal pancreatectomy from January 1,2016 to June 1,2018 were collected,the operations were performed by two operators.The differences of basic information of patients,operation time,blood loss,conversion rate and postoperative complications before and after operation were analyzed with 10 cases,15 cases,20 cases and 25 cases as each node.Results:Forty-four cases were completed by operator A team and 36 cases by the operator B team.The node of surgeon A's learning curve was 15 cases,which showed increasing number of patients with chronic pancreatitis(0 vs.24.14%,P=0.038),but there was no significant difference in operation time,intraoperative blood loss and the incidence of grade B/C pancreatic fistula.The turning point of surgeon B's learning curve was 10 cases,which showed a decrease in the rate of conversion to laparotomy(50%vs.3.8%,P=0.003)and a shortening of operation time[236.00 min(191.30-288.30)min vs.168.00 min(142.50-219.30)min,P=0.008].However,there was no significant difference in the amount of intraoperative blood loss and the incidence of postoperative complications.Conclusions:Even as different operators in the same center,the learning curve of laparoscopic distal pancreatectomy is different.The analysis of learning curve of laparoscopic distal pancreatectomy should be individualized.