胸、腹腔镜食管癌切除术学习曲线分析

Learning curve of esophagectomy with thoracoscopy and laparoscopy for esophageal carcinoma

目的探讨胸、腹腔镜食管癌切除术学习曲线。方法分析2009年9月至2010年12月由作者本人完成的38例胸、腹腔镜食管癌切除术。按手术先后次序分4组(A、B、C、D),A、B、C组每组10例,D组8例,比较各组手术时间、术中出血量、淋巴结清扫个数、中转开胸率、并发症发生率。结果各组手术时间术中出血量虽然有下降趋势,但差异没有统计学意义(P>0.05);无中转开腹,中转开胸率、淋巴结清扫个数、术后并发症发生率各组间差异没有统计学意义(P>0.05)。A+B组手术时间、术中出血量和C+D组手术时间、术中出血量差异有统计学意义(P<0.05)。结论有成熟模式引导,具备一定胸腔镜其他手术操作经验的无胸腹腔食管癌切除经验医师完成胸、腹腔镜食管癌切除术的学习曲线大约为20例。

Objective To analyze the learning curve of esophagectomy with thoracoscopy and laparoscopy for esophageal carcinoma.Methods From September 2009 to December 2010,38 cases of esophagectomy with thoracoscopy and laparoscopy for esophageal carcinoma were performed.Clinical data were collected prospectively and analyzed retrospectively.The patients were divided into 4 groups including group A（n=10）,group B（n=10）,group C（n=10） and group D（n=8） according to the operation order,and the operation time,blood loss,number of resected lymph nodes,rate of thoracotomy conversion and postoperative complications were compared.Results The operation time and blood loss of each group gradually decreased,but the differences were not significant（P〈0.05）.No peritoneotomy conversion occurred.The differences of the number of resected lymph nodes,the rate of thoracotomy conversion and postoperative complications among the four groups were not significant（P〈0.05）.The operation time and blood loss of the group A and group B were significantly different from those of the group C and group D（P〈0.05）.Conclusion The learning curve of esophagectomy with thoracoscopy and laparoscopy for esophageal carcinoma is approximately 20 cases.