后腹腔镜肾部分切除术学习曲线的研究

Study on learning curve for retroperitoneal laparoscopic partial nephrectomy

目的：探讨后腹腔镜肾部分切除术治疗局限性肾癌的学习曲线。方法：回顾性分析我院同一组医师连续开展的40例后腹腔镜肾部分切除术患者的临床资料：按手术先后将40例患者依次分为A组（1～10例）、B组（11～20例）、C组（21～30例）和D组（31～40例），比较各组术中出血量、肾热缺血时间、手术时间、胃肠道功能恢复时间、并发症、术后住院时间等指标。结果：四组患者术中出血量、肾热缺血时间和手术时间差异有统计学意义（P〈0．05）；进一步两两比较发现A组的出血量、肾热缺血时间和手术时间与B组、c组和D组比较，差异有统计学意义（P〈0．05），B组的出血量、肾热缺血时间和手术时间与c组和D组比较，差异有统计学意义（P〈0．05），而C组的出血量、肾热缺血时间和手术时间与D组比较，差异无统计学意义（P〉0．05）。各组患者术后胃肠道功能恢复时间、并发症发生率、术后住院时间比较，差异无统计学意义（P〉0．05）。结论：后腹腔镜肾部分切除术的学习曲线大约为20例，即能达到比较熟练的水平和稳定的程度。

Objective：To explore the learning curve of retroperitoneal laparoscopic partial nephrectomy for lo- calized renal cell carcinoma. Method：A retrospective analysis was made in 40 patients with localized renal cell carci- noma who underwent laparoscopic partial nephrectomy continuously by a sing!e group of surgeons in our hospital. The patients were sequentially divided into group A （1-10 cases）, group B （11-20 cases）, group C （21-30 cases） and group D （31-40 cases）. Clinical data including blood loss, warm ischemia time, operation time, recovery time of gastrointestinal function, complication rate and postoperative hospital stay were compared among them. Result： Differences of the amount of blood loss, renal warm ischemia time and operation time among four groups were sig- nificant （P〈0.05）. By multiple comparison, differences of the amount of blood loss, renal warm ischemia time and operation time between group A and group B, group C, group D were significant （P〈0. 05）. Differences of the amount of blood loss, renal warm ischemia time and operation time between group B and group C, group D were significant （P〈0.05）. There was no significant differences of the amount of blood loss, renal warm ischemia time and operation time between group C and group D （P〉0.05）. There were no statistical differences in the re- covery time of gastrointestinal function, complication rate and postoperative hospital stay among four groups （P〉 0.05）. Conclusion： The learning curve for retroperitoneal laparoscopic partial nephrectomy usually comprises 20 procedures, then surgeons may be skilled in this technique.