机器人系统在子宫内膜癌分期手术中的学习曲线研究

Learning curve of robotic hysterectomy with lymphadenectomy in treatment of endometrial cancer

目的探讨达芬奇机器人系统在子宫内膜癌分期手术中的学习曲线。方法回顾性分析2014年7月~2015年9月解放军总医院妇产科由同组医生完成的45例达芬奇机器人系统子宫内膜癌分期手术患者的临床资料,按手术时间先后顺序依次分为A、B、C组三组：A组15例,手术时间2014年7月~2015年1月;B组15例,手术时间2015年1~5月;C组15例,手术时间2015年5~9月。绘制学习曲线,并比较各组之间手术时间、术中出血量、术中淋巴结清扫数目、术中术后并发症、术后住院天数。结果三组手术时间比较,差异有统计学意义（P〈0.05）,随着手术例数的增加,手术时间逐渐缩短。三组术中出血量、盆腔淋巴结清扫数、腹主动脉旁淋巴结清扫数、术后住院时间比较差异均无统计学意义（P〉0.05）。手术例数与手术时间呈负相关（r=-0.321,P〉0.05）。结论有丰富腹腔镜子宫内膜癌手术经验的手术团队,经过30例的学习曲线,可掌握达芬奇机器人手术系统用于子宫内膜癌分期手术。

Objective To discuss the learning curve and surgical outcome of Da Vinci robotic surgical system for hysterectomy with lymphadenectomy in treatment of endometrial cancer. Methods Clinical data of 45 cases which received Da Vinci robot-assisted hysterectomy with lymphadenectomy performed by the same group of surgeons from July 2014 to September 2015 in Gengneral Hospital of PLA were reviewed retrospectively. The cases were divided into 3 groups according to the sequence of the operation. Group A with 15 cases from July 2014 to January 2015, group B with 15 cases from January to May 2015, and group C with 15 cases from May to September 2015. Learning curve was drawn,and operation time, intraoperatve blood loss, umber of lymph nodes dissection, intraoperative and postoperative complications, postoperative hospitalization time of three groups were compared. Results There was a statistically significant difference between three groups in the operative time（P〈0.05）, and with the increase of operation number, the operation time was shorten. There was no statistically significant difference in intraoperatve blood loss, number of pelvic lymph nodes dissection, number of periaortic lymph nodes dissection, postoperative hospitalization time（P〈0.05）. The operation number was negatively correlated with operation time（r =-0.321, P〈0.05）. Conclusion After about 30 consecutive resections, the surgeons with abundant experiences of laparoscopic surgery for endometrial cancer surgery can overcome the learning curve and master Da Vinci robotic surgical system for hysterectomy with lymphadenectomy in endometrial cancer.