不同学习曲线下腹腔镜胃癌根治术疗效分析

Analysis of Laparoscopic Radical Gastrectomy for Gastric Cancer in DifferentStages of Learning Curve

目的 探讨腹腔镜下胃癌根治术不同学习曲线阶段中遇到的问题和对策.方法 对 2008年1月～12月收治的 32例（A组）和2009年1月～10月收治的35例（B组）腹腔镜下胃癌根治术患者进行回顾分析,对比总结不同学习曲线腹腔镜下胃癌根治术疗效.所有患者按照D2 根治术式,均于上腹部做辅助小切口行病灶移除及消化道重建.将两组患者中转开腹率、手术时间、术中出血量、胃肠功能恢复时间、淋巴结清扫数量、术后住院时间、手术并发症发生率等进行对比,并进行统计学分析.结果 A组成功行腹腔镜下 D2 根治术23例,B组成功行腹腔镜下 D2 根治术33例. A组中转开腹率、术中出血量、手术时间、胃肠功能恢复时间、术后住院时间各项指标明显高于B组（ P〈0.05）;A组淋巴结清扫数量明显少于B组;A组手术并发症发生率高于B组（ P〈0.05）.结论 不同学习曲线对腹腔镜胃癌根治术疗效具有明显影响.腹腔镜胃癌根治术并发症的发生主要与手术者腹腔镜操作技术及腹腔镜器械使用的熟练程度有关.

Objective To investigate the problems and countermeasures of laparoscopic radical gastrectomy for gastric cancer in different stages of the learning curve. Methods Summarizing the learning curve of laparoscopic radical gastrectomy for gastric cancer in 2008 from January to December of 32 cases （group A） and 2009 from January to October 35 cases （group B）.ln accordance with D2 radical surgical, all patients used ancillary small incision in the upper abdomen to reconstruct the digestive tract and remove lesions.The rate of conversion to open surgery,blood loss,operation time, recovery time of gastrointestinal function,number of lymph nodes resected, postoperative hospitalizationtime,and the rate of postoperative complications were compared between the two groups and analyzed statistically. Results Twenty three cases were operated laparoscopic radical gastrectomy for gastric cancer successfully in group A,33 cases were operated laparoscopic radical gastrectomy for gastric cancer successfully in group B.The rate of conversion to open surgery,blood loss,operation time,recovery time of gastrointestinal function and postoperative hospitalization time in group A was significantly higher than that in group B（P〈0.05）;The number of lymph nodes resected in group A was less than the number in group B;The rate of postoperative complications in group A was higher than that in group B（P〈0.05）. Conclusions Different learning curve for laparoscopic radical gastrectomy has a significant effect on the efficacy.The postoperative complications were mainly related to surgical laparoscopic operation techniques and the degree of proficiency of the use of laparoscopic instruments.