单一术者连续118例腹腔镜膀胱癌根治术学习曲线分析

Learning curve of laparoscopic radical cystectomy for a single surgeon of 118 consecutive cases

目的:回顾性分析我院单一术者连续行腹腔镜膀胱癌根治术(LRC)患者的临床资料,评估学习曲线的影响。方法:我院2014年2月～2018年3月接受LRC患者118例,男98例,女20例;其中90例行回肠膀胱术,21例行输尿管皮肤造口术,7例行原位回肠新膀胱术。按时间顺序将病例分为3组(第1组第1～40例,第2组第41～80例,第3组第81～118例),比较3组的手术时间、术中出血等方面的差异。结果:3组患者平均手术时间为(295.59±56.59)min;平均术中出血为(353.64±163.19)ml。第1组、第2组和第3组的平均手术时间分别为(338.00±50.00)min、(283.50±50.55)min和(263.68±40.63)min,第1组与第2组比较差异有统计学意义(P<0.05),第2组与第3组比较差异无统计学意义(P>0.05)。第1组、第2组和第3组的平均出血量分别为(448.00±224.38)ml、(327.25±107.63)ml和(282.11±57.43)ml,术中出血量逐渐下降,而手术时间在40例后呈稳定趋势。结论:LRC治疗膀胱肿瘤是安全有效的,学习曲线相对陡峭。当达到40例手术的积累后,熟练程度明显提高。

Objective：To evaluate our experience and results of laparoscopic radical cystectomy（LRC）and assess the impact of learning curve on perioperative outcomes with LRC by a single-surgeon＇s experience in Peking Union Medical College Hospital.Method：Between February 2014 and March 2018,aprospective study in a single institute on patients with bladder cancer who underwent LRC was conducted.One hundred and eighteen patients（98 men and 20 women）underwent LRC during the 4-year study period.Ninety patients were submitted to ileal conduits,21 patients to ureterocutaneostomies,and 7 to neobladders.The patients were divided into 3 groups according to the time of operation.Operative parameters and perioperative complications were evaluated including operative time,blood loss and perioperative complications.Result：The mean operative time was（295.59±56.59）min,and the mean blood loss was（353.64±163.19）ml.The operative time was（338.00±50.00）,（283.50±50.55）and（263.68±40.63）minutes,respectively,for each group.The intraoperative blood loss was（448.00±224.38）,（327.25±107.63）and（282.11±57.43）ml,respectively,for each group.The intraoperative blood loss was gradually lowered from group one to group three.Significant decline of operative time occurred after every40 cases of LRC（P〈0.05）.Conclusion：LRC is a safe and efficient modality of treatment of bladder cancer.However,it comes with a steep learning curve.This report helps to define the learning curve for LRC and demonstrates an acceptable level of proficiency by the 40 th case.