腹腔镜精索静脉高位结扎术的学习曲线研究

The Learning Curve of Laparoscopic Varicocele Ligation

目的分析腹腔镜精索静脉高位结扎术的学习曲线。方法回顾性分析我中心2010年1月至2011年11月行腹腔镜精索静脉高位结扎术患者的手术相关资料。入组标准:①患者的手术目的为改善精液质量;②双侧精索静脉曲张患者;③自同一医师进行的第一例按照标准方法进行的腹腔镜双侧精索静脉高位结扎术为起始患者。按照手术顺序构建手术时间和术中估计失血量曲线。观察手术时间曲线,根据曲线平台期情况,将所有病例分为A、B、C三组,A组12例;B组16例;C组30例。应用Wilc-oxon秩和检验分别比较A组与B+C组及B组与C组手术时间的统计学差异。并应用独立样本t检验比较A组与B+C组及B组与C组术中估计失血量的统计学差异。结果符合入组标准病例58例,无中转开放病例,无术中输血病例。A组12例患者的平均手术时间为96.67±9.85分钟;B组16例患者的平均手术时间为75±10.49分钟;C组30例患者的平均手术时间为64.33±10.23分钟。A组12名患者的手术时间与B组及C组的46例患者的手术时间差异具有统计学意义(P=0.00001);B组16例患者与C组的30例患者的手术时间差异具有统计学意义(P=0.0001)。A、B及C三组患者的平均术中估计失血量分别为12.92±3.96ml、11.88±5.44ml及15.67±5.68ml,三组术中估计失血量数据符合正态分布(P均>0.05),应用独立样本t检验示三组间术中估计失血量无统计学差异(P>0.05)。结论腹腔镜精索静脉高位结扎术的学习曲线为12例。

Objective To analyze the learning curve of laparoscopic varicocele ligation. Methods All cases of laparoscopic varicocele ligation from Jan. 2010 to Oct. 2011 were collected. The inclusion criteria are: ①the purpose of the operations were to improve the sperm quality; ②Varicoceles of both sides; ③all cases were done by the same urologist from his first case. The operation time and estimated blood loss curve were made by Excel software, and all cases were divided into A、B and C groups by the plateau of the operation time curve, in which, 12 cases in group A, 16 cases in group B, and the other 30 cases in group C. Wilcoxon rank sum test and t test were employed for the analysis of the statistical difference of operation time/ estimated blood loss between group A, B and C. Results 58 cases were collected due to the criteria, with no converted to open surgery case and no blood transfusion case. The mean operation time of group A was 96.67±9.85 minutes and that of group B and C were 75±10.49 minutes and 64.33±10.23 minutes, respectively. The operation time of group A was statistical different from that of the group B and group C (P=0.00001); The operation time of group B was statistical different from that of group C (P=0.0001). The estimated blood losses of group A、B and C were 12.92±3.96 ml, 11.88±5.44 ml and 15.67±5.68 ml, respectively, which showed no statistical difference form one another (P>0.05). Conclusions The learning curve of laparoscopic varicocele ligation was 12 cases.