影响腹腔镜疝修补学习曲线因素的分析

Factors influencing the learning curve of laparoscopic hernia repair

目的评价腹腔镜腹股沟疝修补术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2013年3—11月，南京医科大学鼓楼临床医学院由同一术者开展的连续60例腹腔镜腹股沟疝修补术（LIHR）手术的资料，所有患者按手术先后顺序分为1—5组，每组各12例，观察各组患者手术时间、术中术后不良事件、术后复发率。结果1、2、3组手术时间与4、5组有统计学差异（F=6．603，P=0．000）；术中术后不良事件（并发症）逐渐减少，多可不经处理自行缓解，无严重并发症发生。无修补失败发生，随访期内无复发。结论具有良好腹腔镜操作基础者约在20-30例后即能熟悉LIHR的操作．而真正度过学习曲线、具有很好的控制和处理并发症的能力，至少要达到150～200例。

Objective To evaluate the surgical effects of laparoscopic inguinal hernia repair in different stage, and to investigate the problem of the learning curve. Methods 60 consecutive cases of laparoscopic inguinal hernia repair （LIHR） with a same surgeon in Nanjing Drum Tower Hospital from March 2013 to November 2013, were retrospectively analyzed. All patients were assigned to Group 1 to Group 5, according to the time sequence. 12 cases in each group, and the operation time, adverse events and the recurrence rate were recorded. Results The operation time of Group I to 3, was significantly different from Group 4 and 5 （ F = 6. 603, P = 0. 000） ; postoperative adverse events （complications） were gradually decreasing, and most of them could be improved without treatment. None serious complications and recurrence were observed in follow-up time. Conclusion To learn LIHR, the surgeon must follow the principle of gradual improvement. A learning curve of 20 to 30 cases is necessary for the experienced surgeons. But the number will be at least 150 to 200 cases, when they want to really master this technique and obtain the ability to control and manage the complications.