麦默通微创旋切手术治疗乳腺良性肿物的学习曲线研究

Learning curve for benigh breast lesions excision using Mammotome biopsy system

目的:通过麦默通微创旋切手术治疗乳腺良性肿物,比较不同阶段的手术结果,探讨学习曲线在该术式中的存在。方法:无该手术经验的外科医师完成该手术50例,按时间顺序先后,最初的25例为A组,后面25例为B组。比较两组手术的手术时间、术中出血量、术中疼痛、二次进针例数、术后并发症发生率、术后复查及病理学结果。结果:两组患者年龄、肿物大小、肿物位置等差异均无统计学意义(P>0.05)。A组的手术时间为(39.92±14.96)min,B组的手术时间为(17.52±15.74)min,两者差异有统计学意义(P<0.05)。5天移动平均线呈现一个稳步下降趋势,在26号患者左右开始呈现一个平台期的改变。A组有9例发生术中疼痛,B组有3例发生术中疼痛,两者有统计学差异(P<0.05);B组在术后并发症发生率上较A组稍低,术后常规病理结果中,乳腺纤维腺瘤均占比最大,均无统计学差异(P>0.05)。结论:经过麦默通微创旋切手术治疗乳腺良性肿物25例后,随着医生手术经验的积累可以显著缩短手术时间,可能减少并发症发生率,达到相对熟练和稳定的状态。

Objective Benigh breast lesions excision using Mammotome biopsy system,and to explore the presence of learning curve in this surgery by comparing surgical results in the different stages. Method 50 cases of surgery was completed by a surgeon with no such surgical experience,the first 25 consecutive patients as group A,and the next 25 consecutive patients as group B. And then compared the operation time,blood loss,intraoperative pain et al. Results The general information of the two groups were not statistically different（ P〈0. 05）. The operation time of group A was（ 39. 92 ± 14. 96） min,group B was（ 17. 52 ± 15. 74） min,and the different was statistically significant（ P〈0. 05）. 5 days moving average showing a steady decline and then comes a plateau in the 26 th patient. There were 9 patients who had intraoperative pain in group A,whereas there were only 3 cases in the group B,and the different was statistically significant（ P〈0. 05）; It tended to be that the cmplications of group B was lower than group A,but this result showed no statistically significant（ P〈0. 05）. Conclusion Our data strongly suggest the existence of a learning curve for benigh breast lesions excision using Mammotome biopsy system. After 25 cases of operation,with the improve of surgery experience,surgeons can significantly shorten the operation time,reduce the incidence of complications and relatively achieve a degree of proficiency and stablity.