腹腔镜辅助下高位肛门闭锁肛门成形术的学习曲线

Learning curve of laparoscopic - assisted anorectoplasty for high imperforate anus

目的探讨腹腔镜辅助下高位肛门闭锁肛门成形术的学习曲线。方法回顾性分析首都儿科研究所2008年12月至2015年10月由同一医师主刀完成的60例腹腔镜辅助下高位肛门闭锁肛门成形术的相关临床资料。按手术实施的顺序（即时间顺序），将所收集到的符合标准的病例分为4组，每组15例。对比各组之间的临床资料（手术时间、术中出血量、中转开腹率、术中输血率、术后并发症及术后患儿住院时间）的差异。结果A组手术平均时间（176．3．±41．6）min，B组（128．8±36．1）min，C组（127．3±35．2）min，D组（124．0±30．1）min，4组手术时间呈递减趋势。A组手术时间显著长于B、C、D组，差异有统计学意义（P〈0．05），A组与B组比较差异有统计学意义（P〈0．05）。A组出血量明显多于B、c、D组[A组（17．5±6．5）mL，B组（15．0±5．0）mL，C组（14．5±5．5）mL，D组（8．5±6．5）mL]，4组间差异有统计学意义（P〈0．05），平均出血量为12．7mL。研究中患儿的术后并发症出现率、总住院时间、输血率、术后住院时间之间差异无统计学意义（P〉0．05）。统计数据由A组的平均住院日9．8d缩减到D组的7．4d。结论对于拥有良好外科基础的外科医师来说，腹腔镜辅助下高位肛门闭锁肛门成形术约15例后，手术可达到较为熟练的程度。

Objective To investigate the learning curve of laparoscopy- assisted anorectoplasty in the treat- ment of high imperforate anus. Methods Sixty patients with high congenital anal atresia who were treated with laparos- copy - assisted anorectoplasty in the Capital Institute of Pediatrics from December 2008 to October 2015 by one experience surgeon were selected as observation group. Based on the criteria,the patients were divided into 4 groups（ 15 cases in each group） according to the sequence of the operation and every 15 cases served as a learning phase. The ope- rating time, frequency of operation, complication rate, conversion rate to open surgery, blood loss, the rates of blood transfusion and hospital stay were compared among the 4 phases. Results The mean operation duration was （ 176.3± 41.6） min, （ 128.8 ± 36.1 ） rain, （ 127.3 ± 35.2） rain, （ 124.0 ± 30.1 ） rain in group A, B, C and D, respectively. The operation duration of 4 groups showed a declining trend. Group A has longer operation time than group B, C and D, the difference were statistically significant （ P 〈 0.05 ）. In detail, the comparison of operation time between group A and group B was statistically significant （ P 〈 0.05 ） . Furthermore, group A had significantly more median blood loss than group B, C and D, the differences were statistically significant [ the 4 groups of data, respectively, group A ： （ 17.5 ± 6.5） mL,group B：（15.0±5.0） mL,group C：（14.5 ±5.5） mL,group D：（8.5 ±6.5） mL,P〈0. 05].The mean capacity of blood loss was 12.7 mL. No significant difference was found in surgical complications, the rates of blood transfusion,total hospital stay, and postoperative hospital stay among the 4 groups （ P 〉 0.05 ）. But the postoperative hospital stay decreased from 9.8 d （ group A ） to 7.4 d （ group D）. Conclusions For a well - trained surgeon in imPerforate anus surgery. The learning curve of laparoscopy - assisted anorectoplasty in the treatment of high imperforate anus on about 15 cases helps to make a skillful surgeon.