常规器械经脐腹腔镜胆囊切除术学习曲线分析

Learning curve of transumbilical single-site laparoscopic cholecystectomy with conventional devices

目的：评估常规器械经脐单部位腹腔镜胆囊切除术（transumbilical single-site laparoscopic cholecystectomy,TUSSLC）的阶段疗效,分析其学习曲线。方法 ：回顾性分析2014年3月至2015年1月笔者应用自创的常规器械＂两trocar两切口＂TUSSLC 100例。按手术顺序将病例分为6组,即A组、B组、C组、D组、E组各15例与F组25例。比较各组在性别、年龄、体质量指数、病种及手术时间、术中失血量、手术并发症、术后住院时间方面的差异。绘制学习曲线。结果：各组在性别、年龄、体质量指数及病种方面无统计学差异（P〉0.05）。所有病例均顺利完成常规器械TUSSLC,无术中中转,无术后腹腔内出血、胆道损伤等并发症发生。A组手术时间（59.7±16.7）min大于其余各组（P〈0.05）。各组在术中失血量、术后住院时间方面无统计学差异（P〉0.05）。术后随访6~9个月,随访率100%。无腹痛、发热、黄疸等术后胆道并发症发生,病人对脐部切口恢复的美容效果均满意。结论：常规器械TUSSLC安全可行,学习期估计为11例。掌握此术式特有的操作要点,可能有助于进一步缩短其学习期。

Objective To investigate the effect and learning curve of transumbilical single-site laparoscopic cholecystectomy with conventional devices. Methods A retrospective analysis was made to 100 enrolled patients undergoing transumbilical single-site laparoscopie cholecystectomy with conventional devices by a self-created method so called ＂single site two trocars and two incisions＂ from Mar 2014 to Jan 2015. These consecutive cases were divided into six groups as group A （n=15）, group B （n=15）, group C （n=15）, group D （n=15）, group E （n=15） and group F （n=25）. Demographic data such as gender, age, body mass index and disease entity and surgical data such as operating time, operative blood loss, complications and postoperative hospital stay among the groups were compared. Mathematical model of learning curve was applied and analyzed. Results The demographic data of 100 cases were not different statistically among 6 groups（P〉0.05）. Operations and postoperative recover）＇ of all the patients were all uneventful. Mean of the operating time in group A was （59.7±16.7） min, which was longer than in the other groups （P〈0.05）. A 6-9 months follow-up was performed with 100% rate. The patients were all satisfied with postoperative cosmetic outcomes of the procedure without any biliary complications. Conclusions Transumbilical single-site laparoscopic cholecystectomy with conventional devices is safe and feasible technically. Operation time was optimized after 1 1 cases. The special points in this procedure maybe contribute to shorten learning period.