腹腔镜广泛子宫全切及盆腔淋巴结清扫术的学习曲线

The learning curve of laparoscopic radical hysterectomy and pelvic lymphadenectomy

目的:探讨腹腔镜广泛子宫全切及盆腔淋巴结清扫术的学习曲线。方法:总结80例腹腔镜广泛子宫全切及盆腔淋巴结清扫术的围手术期结果。按手术时间分为4组,每组20例。对比各组出血量、手术时间、淋巴结清扫数量及并发症,并以简单正弦拟合学习曲线。结果:4组患者术前临床资料、肿瘤病理学结果相比差异无统计学意义。第3、4组术中出血量少于第1、2组(P<0.05);手术时间短于第1、2组,差异均有统计学意义(P<0.05);而第3组与第4组手术时间差异无统计学意义(P>0.05)。以简单的振荡正弦曲线Y=sinx-π/2拟合移动平均线,拐点为40例。各组淋巴结清扫数量、并发症发生率差异无统计学意义(P>0.05)。结论:腹腔镜广泛子宫全切及盆腔淋巴结清扫术的学习曲线约为40例,40例后可达到较熟练的水平及稳定程度。

Objective ：To investigate the learning cu.rve of laparoscopic radical hysterectomy （ LRH ） amt pelvic lymphadenectomy. Methods：The clinical data of 80 patients who received LRH and pelvic lymphadenectomy periormcd by the same group of surgeons were reviewed, The cases were divided into 4 groups （ group 1,2,3 and 4） according to sequence of the, operation. The blood loss ,operation time, harvested lymph nodes and complications were compared among the four groups. The learniag curwe was fitted by simple sine curve. Results ：There was no statistical difference in terms with preoperative clinical data or the pathology results of lhe tumors. The blood loss and operation time in group 3 and 4 were significantly less than those in group 1 and 2 （ P 〈 0.05 ） ; the operation time in group 3 and 4 was not significantly different （ P 〉 0.05 ）. The average line was fitted by simple oscillating sine curve （ Y = sinx-π/2 ）, which indicated the inflection point was 40. The number of lymph nodes harvested and complications were not signific, antly different among the 4 groups. Conclusions： The learning curve for LRH and pelvic lymphadenectomy is approximately 40 cases. And the surgeons can achieve a proficient level and stable degree after 40 cases.