腹腔镜直肠癌全直肠系膜切除术的学习曲线研究

Study on learning curve of laparoscopic total mesorectal excision for rectal cancer

目的评估腹腔镜直肠癌全直肠系膜切除术不同阶段的手术效果,探讨腹腔镜结直肠外科医师缩短学习曲线的要点。方法分析2006年1月至2009年10月由同组医师完成的120例腹腔镜直肠癌全直肠系膜切除术患者的临床资料。按手术先后次序分A、B、C3组,每组40例,比较各组手术时间、术中出血量、中转开腹率、并发症发生率、住院时间、标本长度和淋巴结清扫数,分析不同阶段的手术效果。结果 3组病例在年龄、性别、病理分期、肿瘤部位、手术方式无显著差异,A组手术时间、出血量及术后住院时间高于B、C组,差异有统计学意义;B、C组间差异无统计学意义。A组中转开腹例数多于B、C组。各组检获淋巴结数目及标本长度无差异。结论有丰富开腹直肠癌手术经验的固定手术团队,经过40例的学习曲线,可掌握腹腔镜直肠癌全直肠系膜切除手术。

Objective To evaluate the surgical outcomes of laparoscopic total mesorectal excision ( LTME ) for rectal cancer, and to study the key points for surgeons to shorten the learning curve quickly. Methods Clinical data of 120 cases which received LTME performed by the same group of surgeons were reviewed. The cases were divided into 3 groups ( group A , B and C ) according to the sequence of the operation. The frequency of operation, operating time, blood loss, conversion rate to open surgery, incidence of complications, hospital stay and lymph nodes harvested were compared among the three groups. Results There were no significant differences in clinical feature among the three groups. The operating time, blood loss and postoperative hospital stay in group A were significant longer or higher than those in group B and C, while no significant differences were found between the group B and C. The patients with conversion to open surgery in group A were more than those in group B and C. The numbers of lymph nodes harvested were not significantly different among the three groups. Conclusions As for the surgeons with abundant experiences of open total mesorectal excision for rectal cancer, after about 40 consecutive laparoscopic resections, they can overcome the learning curve and master LTME for rectal cancer.