腹腔镜直肠癌根治术的学习曲线研究

Study on learning curve of laparoscopic resection for rectal carcinoma

目的评估腹腔镜直肠癌根治术不同阶段的手术效果,探讨无腹腔镜胆囊切除术经验的外科医师缩短学习曲线的要点。方法分析2009年6月至2010年3月由同组无腹腔镜胆囊切除经验医师完成的45例腹腔镜直肠癌根治术患者的临床资料。按手术先后次序分A、B、C共3组,每组15例,记录手术频率,比较各组手术时间、术中出血量、中转开腹率、并发症、住院天数和淋巴结清扫数,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。各组检获淋巴结数无差异。结论有丰富开腹直肠癌手术经验和内镜经验的固定团队,短期连续大量病例的学习,经过15例的学习曲线,可掌握腹腔镜直肠癌手术。

Objective To evaluate the surgical outcomes of laparoscopic resections for rectal cancer,and to investigate the key points for surgeons without previous training of laparoscopic operation to shorten the learning curve quickly.Methods Clinical data of 45 cases which received laparoscopic rectal resection performed by the same group of surgeons without previous training of laparoscopic operation 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,complications,hospital stay and lymph nodes harvested were compared among the three groups.Results There were no significant differences in age,gender,pathological stage,tumor location and surgical approach 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 rectal cancer resection and endoscope,after 15 consecutive laparoscopic resections,they can overcome the learning curve and master laparoscopic resection for rectal cancer.