腹腔镜下经腹腹膜前修补术治疗腹股沟疝的学习曲线

The learning curve of TAPP inguinal hernia repair

目的探讨腹股沟疝腹腔镜经腹腹膜前修补术的学习曲线。方法回顾性分析2013年1月至2015年3月,重庆市长寿区人民医院200例腹股沟疝腹腔镜经腹腹膜前修补术的围术期效果。按手术先后顺序分成A、B、C、D 4组,每组50例,比较各组术前、术中、术后相应的指标,并以手术时间和手术例数做回归曲线估计。结果术前各组指标比较,差异无统计学意义(P<0.05),A组B组手术时间比较,差异有统计学意义(P<0.05),B组C组手术时间比较,差异无统计学意义(P>0.05),C组D组手术时间比较,差异有统计学意义(P<0.05)。以手术时间和手术例数回归曲线估计可见50例以及150例有拐点。结论腹股沟疝腹腔镜经腹腹膜前修补术学习曲线约为50例,50例后有一个较稳定的水平,150例后熟练程度会进一步提升。经过术前评估以及筛选,学习曲线内主要表现为手术时间的延长。

Objective To investigate the learning curve of laparoscopic transabdominal preperitoneal（ TAPP） inguinal hernia repair. Methods The clinical data of 200 patients who received TAPP in People＇s Hospital of Changshou from January 2013 to March 2015 were reviewed. According to the sequence of operation,the patients were divided into group A,B,C and D with 50 cases in each group. The corresponding parameters in perioperative period were compared among the four groups. The operative time and number of cases were analyzed by regression curve. Results The differences in terms with clinical factors were not statistically significant（ P〈0. 05）. While the differences between group A vs. group B and group C vs group D were significant（ P 0. 05）. No significant difference of operative time between group B and group C was found（ P 0. 05）. The regression curves of the operation time and the number of cases were estimated to indicate the inflection point was 50 and 150. Conclusion The learning curve of TAPP repair is approximately 50 cases. And the surgeons can achieve a stable degree after 50 cases. The proficiency will be further enhanced after 150 cases. This learning curve is only related to longer operation time after strict pre- operative evaluation and appropriate case selection.