腹腔镜膀胱根治性切除术临床疗效分析及学习曲线探讨

Analysis of the clinical efficacy and learning curve of laparoscopic radical cystectomy

目的：评价腹腔镜膀胱根治性切除术（laparoscopic radical cystectomy,LRC）的临床疗效,探讨其学习时间曲线。方法：我院2009年1月2014年1月由同一术者完成膀胱根治性切除-回肠膀胱术72例,其中腹腔镜组34例,开放手术组38例。分析比较两组术式围术期数据、腹腔镜组手术时间随手术例数增多的变化趋势及两种术式在2012年6月2014年1月间的平均手术时间差异。结果：两组患者在年龄、性别及肿瘤分期上的差异均无统计学意义（P〉0.05）。腹腔镜组34例手术全部顺利完成,无一例中转开放手术。腹腔镜组手术总体时间明显长于开放手术组,两组比较差异有统计学意义（P〈0.05）;术中平均出血量、术后肠道功能恢复时间、术后平均住院时间等方面,腹腔镜组优于开放手术组（P〈0.05）;围术期输血率、术后并发症发生率,腹腔镜组低于开放手术组,两组比较差异有统计学意义（P〈0.05）;腹腔组手术时间随手术例数增加逐渐缩短,在2012年6月2014年1月间的两种手术在手术时间上的差异无明显统计学意义（P〉0.05）。结论：LRC是全膀胱切除的一种安全有效的术式,具有较明显的学习时间曲线,当术者熟练掌握腹腔镜技术后,与开放手术比较,开展LRC优势显著。

Objective：To assess the clinical efficacy and explore the learning curve of laparoscopic radical cys- tectomy （LRC）. Method：We retrospectively analyzed the data of 72 patients who underwent radical cystectomy and ileal conduit by the same surgeon in our institute from Jan. 2009 to Jan. 2014. Of these patients, 34 patients un- derwent LRC and 38 patients underwent open radical cystectomy （ORC）. The parameters were analyzed including perioperative data between the two groups, the trends of operative time with increasing number of LRC cases and the mean operation time between the two groups from Jun. 2012 to Jan. 2014. Result：All 34 cases undergoing LRC were successfully completed without conversion to open surgery. There was no significant difference between the two groups in age, sex and tumor stage （P〉0.05）. The mean operating time of LRC group was longer than ORC group, and there was a statistical difference between two groups （P〈0.05）. The mean blood loss, perioperative blood transfusion rate and complication rate, postoperative oral intake and postoperative hospital stay of I.RC group were less than ORC group （P〈0.05）. The mean operation time of LRC gradually shortened with the in- creasing number of cases, and compared with ORC group there was no significant difference from Jun. 2012 to Jan. 2014 （P〈0.05）. Conclusion：LRC is safe and effective for it has an obvious course of learning curve. LRC is superior to ORC for proficient surgeons.