腹腔镜结直肠癌手术学习曲线

Learning Curve of Laparoscopic Radical Operation for Colorectal Cancer

目的探讨腹腔镜结直肠癌手术的学习曲线。方法回顾性分析2008年10月～2011年6月同一组医师连续开展的60例腹腔镜结直肠癌手术,按手术先后次序分为A、B、C 3组,每组20例,3组年龄、性别、Dukes分期和手术方式等方面有可比性。比较各组的手术时间、出血量、淋巴结清扫数目、肠蠕动恢复时间、并发症、中转开腹率和术后住院时间。结果 A、B组的手术时间分别为(242±32)min、(236±28)min,显著长于C组(212±30)min(F=5.58,P=0.006);A、B组的出血量分别为(126±23)ml、(129±30)ml,显著多于C组(105±18)ml(F=5.85,P=0.005)。中转开腹率由A组的20%(4/20)、B组的15%(3/20)下降到C组的5%(1/20)(χ2=2.019,P=0.364)。3组淋巴结清扫数目、肠蠕动恢复时间、并发症发生率和术后住院时间差异无显著性(P>0.05)。结论腹腔镜结直肠癌手术的学习曲线大致为40例。

Objective To investigate the learning curve of laparoscopic radical operation for colorectal cancer （LROCC）. Methods Clinical data of 60 cases of LROCC that were performed between October 2008 and June 2011 by a single group of surgeons were reviewed. The patients were sequentially divided into groups A, B and C with 20 in each. The operation time, blood loss, number of resected lymph nodes, recovery time gastrointestinal function, surgical complications, rate of conversion to open surgery, and postoperative hospital stay were compared among the 3 groups. Results The operation time in groups A and B were significantly longer than that in group C [ （242 ±32） and （236 ±28） minutes vs. （212 ±30） minutes, respectively; F =5.58,P =0. 006]. The patients in groups A and B had more blood loss than those in group C [ （ 126 ± 23 ） and （129 ± 30） ml vs. （105 ± 18 ） ml; F = 5.85, P =0. 005]. The rate of conversion to open surgery was 20% （4/20） and 15% （3/20） respectively in groups A and B, which were significantly higher than that in group C [ 5% （1/20）, X2 = 2. 019, P = 0. 364 ]. No significant difference in the number of resected lymph nodes, recovery time of gastrointestinal function, rate of surgical complications, and postoperative hospital stay among the 3 groups（P 〉 0.05）. Conclusion The learning curve of LROCC include approximately 40 cases.