摘要
目的:探讨机器人辅助腹腔镜肾部分切除术(RAPN)治疗肾肿瘤的学习曲线。方法:回顾性分析2012年5月~2013年8月由单一术者连续完成的40例RAPN患者的临床资料,按手术先后分为4组:第1组(1~10例)、第2组(11~20例)、第3组(21~30例)、第4组(31~40例)。分析对比4组手术时间、热缺血时间、并发症、肾功能等指标。结果:4组患者年龄、肿瘤最大径、R.E.N.A.L.评分等基线数据差异无统计学意义,而手术总时间[(202.20±18.06)min、(194.70±11.68)min、(160.30±14.28)min、(155.20±22.29)min,P<0.01]、热缺血时间[(31.80±10.73)min、(27.10±4.56)min、(16.85±7.01)min、(15.00±6.32)min,P<0.01]的差异有统计学意义,且随着例数增多,呈现逐渐下降的趋势。术中出血量虽呈现下降趋势,但各组之间差异并无统计学意义[(145.00±59.86)ml、(140.00±65.83)ml、(115.00±47.43)ml、(110.00±31.62)ml,P=0.360]。两两对比发现第1组和第2组、第3组和第4组在手术时间和热缺血时间上差异并无统计学意义(P>0.05),而第2组和第3组之间差异有统计学意义(P<0.01)。结论:对于一位有着丰富腹腔镜手术经验的术者,实现普通腹腔镜到RAPN的过渡是一个顺利、快速的过程,学习曲线为15~20例。学习曲线存在个体差异性,术者应根据自身经验选择合适患者,实现手术效果的最优化。
Objective:To investigate the learning curve of robot-assisted partial nephrectomy(RAPN).Method:We retrospectively analyzed 40patients' clinical data who received RAPN continuously by a single surgeon between May 2012 and Aug.2013.The patients were sequentially divided into the first group(1-10cases),second group(11-20cases),third group(21-30cases)and the fourth group(31-40cases).Clinical parameters including operative time,warm ischemia time,estimated blood loss,renal function,et al.were compared among four groups.Result:No significant difference of age,tumor diameter or R.E.N.A.L score was observed among four groups.By multiple comparison,difference of operative time(202.20±18.06 min,194.70±11.68 min,160.30±14.28 min,155.20±22.29 min,P〈0.001)and warm ischemia time(31.80±10.73 min,27.10±4.56 min,16.85±7.01 min,15.00±6.32 min,P〈0.001)was significant among four groups with descending trend.Although similar trend was observed in estimated blood loss,there was no statistical significance(145.00±59.86 ml,140.00±65.83 ml,115.00±47.43 ml,110.00±31.62 ml,P=0.360).There was significant difference of operative time,warm ischemia time between the second and third group.Conclusion:The transition from laparoscopy to RAPN is a feasible and rapid process.The learning curve is 15-20 cases.In consideration of individualized difference,optimal patients should be chosen based on surgeon's experience.
出处
《临床泌尿外科杂志》
2017年第8期589-591,共3页
Journal of Clinical Urology
基金
国家自然科学基金(编号81572521)
上海市青年科技英才扬帆计划(编号16YF1403600)
关键词
肾肿瘤
机器人辅助腹腔镜
肾部分切除术
学习曲线
kidney neoplasm
robot-assisted laparoscopy
partial nephrectomy
learning curve