右胸微创切口心脏不停跳房间隔缺损修补手术学习曲线

The learning curve of atrial septal defect closure on beating heart through a right minimally invasive incision

目的 总结右胸微创切口心脏不停跳房间隔缺损修补手术学习曲线.方法 回顾性分析2011年6月至2013年4月间由同一术者连续完成的60例右胸微创切口心脏不停跳房间隔缺损修补手术病例资料,按手术先后顺序分为A、B、C、D 4组,每组15例.从各组手术时间、体外循环转机时间、中转开胸率、术后24 h引流量、ICU停留时间及手术并发症等指标比较手术效果,同时使用对数曲线拟合学习曲线,得出学习曲线相关模型.结果 各组病例年龄、性别差异无统计学意义（P＆gt;0.05）.全部患者均成功完成手术,手术时间、转机时间、中转开胸率、术后24 h引流量、ICU停留时间、术后并发症发生率等指标随手术例数增加呈下降趋势,且各组间差异有统计学意义（P〈0.05）.此外,学习曲线相关模型为：手术时间（min）=143.5-16.7×ln（手术例数）,转机时间（min）=77.5-13.0×ln（手术例数）.结论 右胸微创切口心脏不停跳房间隔缺损修补术是安全可行的,手术学习曲线约为30例左右.

Objective To investigate the learning curve of atrial septal defect closure on beating heart through a right anterolateral thoracotomy. Methods Our study reviews retrospectively the results of a consecutive series of 60 patients whose atrial septal defect was closed on beating heart through a right anterolateral thoracotomy between June 2011 to April 2013. The procedure was performed by the single surgeon and the patients were divid- ed into 4 groups （groupA, B, C, D, n=15 in each group） according to the sequence of the operation. The opera- tive time, extracorporeal circulation time, the rate of conversion to median sternotomy, the drainage volume of the first 24 hours after operation, the intensive care unit （ICU） stay and postoperative complications were compared a- mong the 4 groups. Learning curves were assessed by means of regression analysis with logarithmic curve fit. Re- suits There were no statistically significant differences between the 4 groups with respect to age and gender （P〉 0.05 ）. All the cases were accomplished successful. The operative time, extracorporeal circulation time, the drainage volume of the first 24 hours after operation and the ICU stay all decreased as time goes by, and the differences a- mong the 4 groups was significant（P〈0.05 ）. Significant learning curves were noted for operative time（OT） y （rain） =143.5-16.7xln（x）, r2=0.918,P〈0.05, and extracorporeal circulation time（ECT） y （min）=77.5-13.0xln（x）, r2=0.821 ,P〈0.05. [The x shows consecutive atrial septal defect （ASD） case number]. Conclusion The learning curve of atrial septal defect closure through a right anterolateral thoracotomy is approximately 30 cases, and the technology can be spread and used widely.