腹腔镜结直肠手术学习曲线影响因素分析

Analysis of the influence factors of early stage on learning to perform laparoscopic colorectal surgery

目的 :探讨腹腔镜结直肠手术学习曲线影响因素。方法:回顾性分析2006年1月—2009年12月100例腹腔镜结直肠手术的临床资料,固定手术团队,按手术先后次序分为5组,每组20例,以每20例为一手术的学习阶段,比较各阶段的肿瘤部位及分期、手术方式、手术时间、手术频度、中转开腹率、并发症发生率、术后住院时间以及患者术后生存时间等,分析不同阶段的手术类型及近远期手术效果。结果:5组患者在肿瘤部位及分期、手术方式、并发症发生率、中转开腹率及术后生存时间等方面无显著差异,但手术时间、手术频度及术后住院时间存在组间差异。结论:行腹腔镜结直肠手术约40例后,手术技术即可达到较为熟练的状态,手术例数及手术频度是重要影响因素,但手术熟练程度对患者的近、远期疗效无显著影响。

Objective：To investigate the influence factors of early stage on learning to perform laparoscopic colorectal surgery.Methods：Clinical date of 100 cases which received laparoscopic colorectal surgery from J an.2006 to Dec.2009 were analyzed retrospectively.The patients were divided into 5 groups（n=20）according to the sequence of the operation and every 20 cases was a learning phase.The tumor site and staging,operating time frequency of operation,complication rate,conversion rate to open surgery,hospital stay and survival time were compared among the 5 phases.The operative effects in different phases were analyzed.Results：There was no significant difference in the patients among the 5 different phases with respect to tumor site and staging,surgical procedures,complication rate,conversion rate to open surgery and survival time.However,There were significant differences in the operating time,frequency of operation and hospital stay among all groups.Conclusions：The learning curve was approximately 40 cases＇ practice for mastering the laparoscopic colorectal surgery skills.Apart from the amounts of operation,the frequency of operation is also an important factor.