完全腹膜外腹腔镜疝修补术(TEP)的学习曲线分析

Learning curve analysis of totally extraperitoneal prosthesis

目的评价完全腹膜外腹腔镜疝修补术(totally extraperitoneal prosthesis,TEP)不同阶段的手术效果,探讨其学习曲线问题。方法回顾性分析2010年10月至2012年10月合肥市第一人民医院微创外科由同一手术团队完成的60例完全腹膜外腹腔镜疝修补术,均为男性单侧腹股沟斜疝,不包括双侧腹股沟疝、直疝及复发疝。按施行手术的时间次序分为6组(A、B、C、D、E、F),每组10例。比较各组手术时间、术中出血量、中转手术率、术中术后并发症、术后住院时间。分析不同阶段的手术效果。结果 6组患者在年龄、疝类型构成、基础疾病构成比方面差别无统计学意义(P>0.05)。后5组手术时间、术中出血量及术后住院时间明显少于A组(P<0.05)。中转手术率、术中术后并发症方面差异无统计学意义(P>0.05)。结论有丰富的腔镜手术基础和腹股沟疝的解剖基础及传统手术经验的微创外科医师,TEP的学习曲线约为10例。

Objective To evaluate the surgical outcomes in different stages of totally extraperitoneal prosthesis and to investigate the learning curve of totally extraperitoneal prosthesis.Methods Sixty cases of totally extraperitoneal prosthesis in our department of minimally invasive surgery were reviewed,and the cases were divided equally into 6 groups（group A,B,C,D,E and F） according to the time sequence of the operations.The operating time,blood loss,conversion to open surgery,postoperative hospital stay,intraoperative and postoperative complications were compared.Results There were no statistical differences among the groups in age（P 0.05）.The operating time,blood loss and postoperative hospital stay of group A was significantly more than those of groups B,C,D,E and F（P 0.05）.Conversion to open surgery and intraoperative and postoperative complications had no statistical differences（P 0.05）.Conclusion The learning curve of totally extraperitoneal prosthesis for surgeons who have experience in inguinal hernia repair,laparoscopic technology and inguinal hernia anatomy is approximately 10 cases.