腹腔镜结直肠手术的学习曲线

Learning Curve of Laparoscopic-Assisted Colorectal Surgery.

目的 :评估腹腔镜结直肠手术不同阶段的手术效果 ,探讨腹腔镜结直肠手术学习曲线问题。方法 :回顾性分析我院微创外科中心 1993年 6月至 2 0 0 2年 3月 10 0例腹腔镜结直肠手术病例 ,主刀医师为第一作者。以每 2 5例手术病人为一手术的学习曲线阶段 ,比较 4阶段手术时间、术中术后并发症发生率、中转开腹率、术后住院时间等 ,分析不同阶段的手术效果。结果 :4阶段手术病例在年龄、性别、既往腹部手术史、手术方式等方面无明显差别。早期2 5例手术平均时间为 180 (180± 2 3.3)min ,1例输尿管损伤 ,住院时间 15 .3d ,中转开腹率 16 %。后期 75例手术平均时间为 12 5 (12 5± 16 .5 )min(P <0 .0 0 1) ,无术中及术后严重并发症。住院时间 14.5d(P <0 .0 5 ) ,中转开腹率4.0 % (P <0 .0 5 )。结论 :腹腔镜结直肠手术的学习曲线大约为 2

Objective: To evaluate the outcomes of laparoscopic-assisted colorectal resection and to define the learning curve of laparoscopic colorectal resections. Methods: Data of 100 cases of laparoscopic colorectal resections performed by first author from 1993 to 2002 were reviewed and every 25 cases operated laparoscopically was taken as a phase of leaning curve. The outcomes of operating time, intra- and post-operative complications, conversion rate into open surgery and hospital stay of 4 phases of learning curve were compared. Results: There was no significant differences among the patients in the four different phases with respect to age,operation pattern, past history of operation on abodominal region. Mean operating time was 180(180±23.3)min in early experience and declined to a steady state (125 min±16.5 min, P<0.001) . Urethra injury was occured in one case in the first phase. No severe intra- and post-operative complications was occurred. The time of post-operative hospitalization(15.3 d vs 14.5 d, P<0.05) and conversion rate into open surgery (16% vs. 4.0%, P<0.05) declined significantly with progress of the phases of learning curve. Conclusions: The learning curve of laparoscopic colorectal resections was approximately 25 cases.