全胸腔镜下解剖性肺段切除术治疗早期NSCLC的学习曲线研究

Study on the learning curves of total thoracoscopic anatomical segmentectomy in the treatment of early NSCLC

目的:探讨全胸腔镜下解剖性肺段切除术治疗早期非小细胞性肺癌(NSCLC)的学习曲线。方法:收集2018年1月~2020年3月本院60例行全胸腔镜下解剖性肺段切除术的早期NSCLC患者的临床资料,进行回顾性分析,按行手术的时间先后次序将患者依次分成A、B、C、D四组,各15例,分析比较各组一般资料(包括年龄、性别、肿瘤部位、肿瘤大小、操作孔数量),以及各组手术时间、术中出血量、中转开胸率、术后住院时间、术后并发症、淋巴结清扫站数及个数、术后胸管引流时间,比较不同时间的手术效果,绘制学习曲线,用累积求和法分析跨越学习曲线所需要积累的最低手术例数。结果:各组在性别、年龄、肿瘤部位、肿瘤大小上均无明显差异;A组手术时间明显长于B组,B组手术时间明显长于C组,而C组和D组手术时间无明显差异;A组术中出血量明显多于B组,B组术中出血量明显多于C组,而C组和D组术中出血量无明显差异;各组在中转开胸率、术后住院时间、术后并发症、淋巴结清扫站数及个数、术后胸管引流时间上均无明显差异;在以手术时间与术中出血量为纵坐标的学习曲线中,累积求和法结果显示,当CUSUM值为0时,对应的病例数均为30例。结论:全胸腔镜下解剖性肺段切除术治疗早期NSCLC的学习曲线约为30例。

Objective To explore the learning curves of total thoracoscopic anatomical segmentectomy in the treatment of early non-small cell lung cancer(NSCLC).Methods The clinical data of 60 patients with early NSCLC who underwent total thoracoscopic anatomical segmentectomy in the hospital from January 2018 to March 2020 were collected for retrospective analysis.According to order of operation time,they were divided into group A,B,C and D,15 cases in each group.The general data(age,gender,tumor sites,tumor size,number of operation hole),operation time,intraoperative blood loss,conversion rate to thoracotomy,postoperative hospitalization time,postoperative complications,stations and number of lymph node dissection,postoperative drainage time of chest tube and surgical effect were analyzed and compared among all groups.The learning curves were drew.The minimum number of surgical cases that needed to be accumulated in leapfrogging learning curves was analyzed by cumulative summation method.Results There were no significant differences in gender,age,tumor sites,tumor size and number of operation hole among all groups.The operation time in group A was significantly longer than that in group B,which was significantly longer in group B than group C.There was no significant difference in operation time between group C and D.The intraoperative blood loss in group A was significantly more than that in group B,which was significantly more in group B than group C.There was no significant difference in intraoperative blood loss between group C and D.There were no significant differences in conversion rate to thoracotomy,postoperative hospitalization time,postoperative complications,stations and number of lymph node dissection,and postoperative drainage time of chest tube among all groups.In the learning curves with the operation time and intraoperative blood loss as the ordinate,the results of cumulative summation method showed that when CUSUM value was 0,the corresponding number of cases was 30 cases.Conclusion The number of learning curves of total thoracoscopic anatomical segmentectomy in the treatment of early NSCLC is about 30 cases.