机器人远端胃癌根治术的学习曲线

Learning curve of robot-assisted radical distal gastrectomy for gastric cancer

目的探讨机器人远端胃癌根治术的学习曲线。方法回顾分析南昌大学第一附属医院普外科同一组团队2015年2月至5月完成的30例机器人远端胃癌根治手术患者的临床资料。按患者进行手术的时间先后分为A、B、C组,每组10例,比较3组的机器人安装时间,以及反映术中情况和术后恢复情况的数项指标。结果 3组患者的年龄、性别、术前体质量指数、既往腹部手术史及术前分期、手术方式比较,差异均无统计学意义(P>0.05);与A组相比,B、C组的机器人安装时间短[A、B、C组分别为(28.5±6.3)min、(15.1±4.5)min、(14.7±2.9)min,P<0.05],手术时间短[A、B、C组分别为(272.3±46.1)min、(206.4±38.3)min、(202.5±40.3)min,P<0.05],术中出血量少[A、B、C组分别为(131.3±10.1)ml、(61.4±16.3)ml、(59.8±17.9)ml,P<0.05],淋巴结清扫数量多[A、B、C组分别为(18.4±4.1)枚、(25.7±4.6)枚、(26.3±4.8)枚,P<0.05]。B、C组比较,均差异无统计学意义(P>0.05)。3组的肛门排气时间、术后住院时间及并发症发生率比较,差异无统计学意义(P>0.05)。A组的10例手术在2个月内完成,平均每个月5台手术;B组和C组的手术均在1个月内完成,平均每个月10台手术。结论有丰富腹腔镜远端胃癌手术经验的外科医师行机器人远端胃癌根治术的学习曲线约为10例,手术频度为平均每个月5例。

Objective To investigate the learning curve of robot-assisted radical distal gastrectomy for gastric cancer. Methods In order to analysis the clinical data of 30 patients undergoing robot-assisted radical distal gastrectomy from Feb. to May 2015 in our department by same group, the patients were divided into three groups, with 10 cases in each one, marked by A,B and C. Several indexes were used to compared the differences among the 3 groups. Results There were no significant differences in age,sex,pre-operative body mass index （BMI） ,previous history of abdominal operation,pre-operative TNM stages resection types of the stomach among the three groups （P 〉0. 0 5 ） . The robotic set-up time of group B and group C was shorter than that of group A, [ （28. 5 ± 6.3）min,（1 5 .1 ± 4 . 5 ） min,（ 14. 7 ± 2. 9 ）min for group A , B and C respectively ,P 〈 0. 05 ] ; The operation time of group B and group C was shorter than that of group A [（272.3 ± 46.1） min, （206.4 ± 38.3） min, （202.5 ± 40.3） min for group A,B and C respectively, P 〈0. 05] ;the blood loss of group B and group C was less than that of group A [ （ 131. 3 ± 10.1 ） ml, （61.4±16. 3） ml,（59. 8±17. 9 ） ml for group A , B and C respectively,P〈 0. 05 ] ; the number of lymph nodes resected in group B and group C was more than that in group A [（18.4 ± 4 . 1 ）,（25. 7±4.6）,（26.3±4.8） for group A,B and C respectively,P〈0 . 05] ; no significant difference was found between group B and group C （ P 〉 0. 05 ） ; no significant difference was found in exhaust time, postoperative hospital stay and complication rates among the three groups （ P〉 0.05 ） . The 10 patients in group A received the operation within a time period of 2 months （5 cases per month） , and groups B and C were done gastrectomy for gastric cancer at the months frequency of 5 cases.