机器人胰体尾切除术学习曲线分析(附71例报告)

Analysis of learning curve of robotic distal pancreatectomy:a report of 71 cases

目的分析单中心开展机器人胰体尾切除术(RDP)的学习曲线,并与文献报道进行比较。方法回顾性分析2012年1月至2018年5月中国医学科学院北京协和医院基本外科收治的71例行RDP病人的临床资料,利用累积求和法分析RDP的学习曲线,并对比度过学习曲线前后的手术并发症的发生率。结果肿瘤直径为(4.0±2.1)cm,手术时间为(227.7±83.1)min,无术后90 d死亡病例。3例(4.2%)中转开放手术,8例(11.3%)发生B级胰瘘,2例(2.8%)术后出血并行二次手术探查止血,3例(4.2%)腹腔感染,3例(4.2%)出现术后胃排空障碍,3例(4.2%)出现Clavien-DindoⅢ级并发症,无Ⅳ、Ⅴ级并发症。RDP的学习曲线可以分为3个阶段,48例后被认为度过学习曲线,平均手术时间由260.6 min降至159.0 min(P<0.05),总并发症的发生率由25.0%降至4.3%(P=0.048)。结论 RDP学习曲线反映了手术团队学习掌握该技术、扩大手术适应证、开展团队成员培训的综合过程,开展初期的微创技术基础、开展过程中团队成员的变化等均可影响学习曲线。

Analysis of learning curve of robotic distal pancreatectomy：a report of 71 cases XU Qiang,WU Wen-ming,HAN Xian-lin, et al. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medial Sciences,Beijing 100730,China Corresponding author：ZHAO Yu-pei,E-mail： zhao8028@263.net Abstract Objective To analyze the learning curve for robotic distal pancreatectomy （RDP） in one pancreatic center and review the literature on learning curves for RDP. Methods All patients underwent RDP at Peking Union Medical College Hospital between 2012 and 2018 were analyzed retrospectively. Learning curve analysis was performed by cumulative summation（CUSUM） analysis of operative time. Results Between 2012 and 2018, 71 patients underwent RDP. There was no 90-day mortality. In 3 patients （4.2%）, surgery was converted to laparotomy. Two patients （2.8%） required re-operation for the postoperative bleeding. Three patients （4.2%） had postoperative abdominal infection and 3 patients （4.2%） had delayed gastric emptying. Precipitous operative time reduction from an initial operative time of 260.6 min was observed after the first 48 cases to 159.0 min （P=0.000）, and morbidity was also reduced from 25.0% to 4.3%（P=0.048）. Conclusion RDP is safely feasible in selected patients and the learning curve is completed after 48 operations. The learning curve reflects a comprehensive learning process of a surgical team, being affected by many factors.