腹腔镜结直肠癌根治术学习曲线

Learning curve of laparoscopic assisted radical operation for colorectal cancer

目的探讨外科医师如何尽快掌握腹腔镜结直肠癌根治术。方法分析2000年9月至2003年5月由同一组医师完成的50例腹腔镜结直肠癌根治术,按手术先后次序分5组,每组10例,比较各组手术时间、术中出血量、术后肛门排气时间、术后住院天数和各组病灶的位置和术后并发症发生率、腹腔镜手术占同期同类手术比例和3站淋巴结清扫数目及其总数的差异。结果A组手术时间由(314.5±34.4)min至E组降为(186.0±27.6)min(P=0.000),术中出血量由(94.0±25.5)ml降至(15.5±18.3)ml(P=0.000)。肛门排气时间、住院天数、病灶的位置、术后并发症发生率、3站淋巴结清扫数及总数各组比较,差异均无显著性意义(P>0.05)。但E组无术中并发症及中转开腹。腹腔镜手术占同期同类手术总数由A组的15.2%(10/66)至E组上升为47.6%(10/21)(P=0.004);全组吻合口瘘发生率为2.0%(1/50),局部复发率为4.0%(2/50)。结论腹腔镜结直肠癌根治术学习曲线大约为40例,即可达到较熟练程度。

Objective To investigate how surgeons can quickly learn laparoscopic radical operation for colorectal cancer(LROCC). Methods Clinical data of 50 cases in whom LROCC was performed by a group of surgeons from 2000 to 2003 were reviewed. The patients were divided into five groups(10 cases in each group) by operative sequence. The operating time,bleeding volume,postoperative aerofluxus time,hospital stay,cancer location,postoperative complications,the rate of conversion to open operation,proportion of laparoscopic operations among the total radical colorectal operations during the same period,number of removed lymphatic nodes were compared among the 5 groups. Results The operating time in group A was(314.5±34.4)min and decreased to(186.0±27.6)min in group E(P=0.000). The bleeding volume decreased from (94.0±25.5)ml in group A to (15.5±18.3)ml in group E(P=0.000). There was no significant difference in aerofluxus time,hospital stay,cancer location,postoperative complications,number of removed lymphatic nodes(P >0.05). There were no intraoperative complications and conversion to open operation in group E. The proportion of laparoscopic operations among the total radical colorectal operations during the same period increased from 15.2%(10/66) in group A to 47.6%(10/21) in group E(P=0.004). The incidence of anastomotic leak was 2.0%(1/50) and local recurrence was 4.0%(2/50) in total cases. Conclusion From the learning curve of LROCC,surgeons can learn such skill after performing 40 cases of LROCC.