腹腔镜辅助直肠癌手术的学习曲线分析

Learning curve of laparoscopic-assisted surgery for rectal cancer

目的 通过比较腹腔镜辅助直肠癌手术术者不同阶段的手术结果，结合文献，探讨腹腔镜辅助直肠癌手术的学习曲线。方法回顾性分析中国医学科学院肿瘤医院腹部外科2007年5月至2009年12月接受腹腔镜辅助直肠癌手术的患者160例。按手术先后顺序，以每15例和每20例为一学习曲线阶段，将所有病例分为11阶段和8阶段两种比较方式，应用SPSS13．0软件，采用单因素方差分析，分别比较各阶段在淋巴结检出数目、下切缘长度、手术时间、术中出血量、手术并发症、中转开腹及术后住院时间等方面的差异，同时分析两种比较方式除外第1阶段，剩余阶段在上述指标间的差异。结果各阶段手术病例在淋巴结检出数目（12．8～18．2个）、下切缘长度（2．8～3．3cm）、术中出血量（156．0～273．3m1）及术后住院时间（9．4—14．0d）等方面差异均无统计学意义，第1阶段的手术并发症、中转开腹率稍高，但差异无统计学意义。两种比较方式第1阶段的手术平均时间分别为201．0min和193．0min，均与其余各阶段比较差异有统计学意义（P〈0．001），仪第2种比较方式的手术时间在剩余各阶段无明显差异。结论腹腔镜辅助直肠癌手术经过16～20例手术可达较熟练和稳定程度。

Objective To investigate the learning curve of laparoscopic-assisted surgery for rectal cancer by comparing the effects of laparoscopic,assisted rectal surgery at different stages with a literature review. Methods A total of 160 surgical cases of laparoscopic-assisted rectal cancer from May 2007 to December 2009 were reviewed. Different standards were used to divided them into 11 stages （group 1 ： 15 cases in each） and 8 stages （group 2：20 cases in each） respectively by operative sequences. The number of revealed lymph nodes, length of distal margin, operating duration, blood loss volume, the incidences of intraoperative and postoperative complications, the rate of conversion into open operation and the length of postoperative hospital stay were analyzed. With the exception of the first stage, all indices in the remainder of 10 stages and 7 stages were analyzed simultaneously. Results There was no significant differences among the 11 stages and 8 stages with the respect to the number of revealed lymph nodes, length of distal margin, blood loss volume, the incidences of intraoperative and postoperative complications, the rate of conversion into open operation and the length of postoperative hospital stay. The average operating duration in the first stage of group 1 was 201.0 min and 193.0 min in the first stage of group 2. And the operating, duration in the first stage in the two groups was longer significantly than the remainder of stages in each group （P 〈 0. 001）. Conclusion A surgeon may become experienced in laparoscopic-assisted rectal surgery by operating 16 -20 patients with rectal cancer.