腹腔镜下复杂子宫肌瘤剔除术学习曲线研究

Learning curve of laparoscopic complicate myomectomy

目的 评估腹腔镜下复杂子宫肌瘤剔除术不同阶段的手术效果,探讨腹腔镜下复杂子宫肌瘤剔除术的学习曲线.方法回顾性分析2002年5月～2010年5月安徽医科大学附属省立医院由同一组手术医生完成的117例腹腔镜下复杂子宫肌瘤剔除术患者的临床资料.以简单正弦拟合两周期点将资料按手术日期先后次序分为6组（A、B、C、D、E为每组20例,F组17例）.比较各组平均手术时间、术中平均出血量、中转开腹率、手术输血率、术后病率、术后感染率、术后平均住院时间,分析不同阶段的手术效果.结果 手术时间A组（117.3±19.9） min,大于B组（102.9±18.9）min、C组（85.9±8.5）min、D组（95.1±20.1）min、E组（84.1±15.8）min和F组（92.4±11.5）min,术中出血量A组（164.7±25.4）ml,大于B组（140.2±28.5）ml、C组（127.8±22.9）ml、D组（126.5±26.3）ml、E组（120.9±22.4）ml和F组（120.2±15.7）,差异均有统计学意义;术后平均住院时间A（5.6±1.0）d、B（5.4±1.0）d、C（5.5±0.8）d、D（5.2±0.8）d和E（5.0±1.0）d,5组比较,差异均无统计学差异,5组术后平均住院时间大于F组（4.6±0.8）d,差异有统计学意义;手术输血率A组占25%、B组占10 %、C组占5 %、D组占5 %、E组和F组为0,呈逐渐下降趋势,差异有统计学意义;6组中转开腹率、术后病率和术后感染率比较,差异均无统计学意义.6组均无严重并发症发生.结论 随着手术病例增多,手术时间缩短,术中出血量减少,手术输血率呈逐渐下降,住院时间、转开腹率、术后病率和术后感染率变化不大;腹腔镜下复杂子宫肌瘤剔除术的学习曲线大约为20例.

Objective To evaluate the surgical outcomes of laparoscopic complicate myomectomy and to define the learning curve of laparoscopic complicate myomectomy. Methods Retrospective analysis of the first 117 consecutive cases of laparoseopic complicate myomcctomy performed by a group of surgeons. Patients were divided into six groups [ A （ n = 20）, B （ n = 20）, C （ n = 20）, D （ n = 20）, E （ n = 20）, F （ n = 17） ] according to the primary two cycles end, operating time, estimated blood loss, postoperative hospital stay, conversion to laparotomy, rate of postoperative infection, blood transfusion, and postoperative morbidity. Results The six groups were similar with regard to baseline characteristics. The mean operating time （mean ± sd） of group A （ 117.3 ±19. 9 min） was significantly longer than group B （ 102. 9 ±18.9）, C （ 85.9 ± 8.5）, D （95. 1 ±20. 1）, E （84. 1 ±15.8）, and F （92.4±11.5） （P〈0.05）. Significant more blood loss was observed in group A （164.7 ±25.4 ml） than in Group B （140.2 ±28.5 ml）, C （127.8 ±22.9）, D （I26.5 ±26.3）, E （120.9± 22. 4）, and F （ 120. 2 ±15.7） （P 〈0. 05）. Group F （4. 6 ±0. 8 day） had shorter mean postoperative hospital stay in comparison with Group A （5.6±1.0）, B （5.4±1.0）, C （5.5 ±0.8）, D （5.2±0.8）, andE （5.0±1.0）（P〈0.05）. Frequency of blood transfusion showed a decreasing trend from group A （ 17. 9 % ）, B （ 10 % ）, C （5 % ）, D （5 % ）, E （0）, to F （0） （P 〈 0. 05）. There were no significant differences between the six groups with respect to the rate of conversion to laparotomy, postoperative morbidity, and rate of postoperative infection. No severe complications were observed in any of the cases. Conclusion The learning curve of laparoscopic complicate myomcctomy is approximately 20 cases.