腹腔镜下完全腹膜外腹股沟疝修补术学习曲线

Learning curve of totally extraperitoneal hernia repair(TEP)

目的针对已经熟练掌握腹腔镜操作基础的外科医师,探讨腹腔镜下完全腹膜外腹股沟疝修补术(TEP)的学习曲线。方法回顾性分析2010年8月至2012年1月由同一术者行TEP治疗腹股沟疝患者50例,按开展手术的时间先后顺序分为A、B、C、D、E组,每组10例患者,每10例做一次阶段总结。各组患者在年龄、疝类型上差异均无统计学意义(P>0.05),比较患者手术时间、术中及术后并发症发生率,分析不同阶段的手术效果的差异。结果手术时间各组间差异有统计学意义(F=34.977,P=0.000),在手术时间上A、B组和C、D、E之间差异均有统计学意义(P<0.05),C、D、E三组患者之间差异均无统计学意义(P>0.05),经过20例患者后,后三个阶段术中出血、腹膜分破、层次走错等现象明显减少,从而手术时间也随之缩短。结论学习TEP手术是个渐进的过程,具备腹腔镜操作基础的术者完成约30例后开始熟悉腹腔镜下完全腹膜外疝修补的手术入路,从而进一步缩短手术时间。

Objective To investigate the learning curve of totally extraperitoneal hernia repair （TEP） in the experienced surgeons who developed laparoscopic operation bases. Methods A total of 50 patients with TEP from Aug 2010 to Jan 2012 were reviewed. Five subgroups （ 10 cases in each group） classified by operation sequence were included in the study. No significant difference （ P 〉 0.05 ） among the patients in the 5 different phases with respect to age,the type of hernia was observed. The preoperative general physical conditions, operating time, the incidence of intraoperative and postoperative complications from 5 phases of learning curves were compared. The operative efficacy in different phases were analyzed. Results There were differences （ F = 34.977, P = 0. 000） in the operation time （ P 〈 0.05 ） among A, B and C, D,E but no any difference （ P 〉 0.05 ） among each group of C,D ,E. After practice with 20 eases, bleeding, peritoneal damage,level errors,and the operation time were significantly improved. Conclusions TEP learning is a step-by-step process. After practice with 30 cases, the technical skills of laparoscopic operation could be fully developed and the operating time could be shortened accordingly.