腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术的学习曲线研究

Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy

目的评估腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术学习过程中不同时期的手术时间及并发症,探讨腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术的学习曲线。方法回顾性分析连续79例由单个外科医师独立行腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术患者的临床资料,按手术先后次序分7组,最后1组13例,比较各组手术时间、中转率、住院时间及术后感染性并发症,来界定腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术学习曲线。结果各组病例年龄、性别、体重及病理等方面差异无统计学意义(P>0.05),学习曲线早期(A组)平均手术时间为(292.7±29.8)min,学习曲线后期(B组)手术时间为(215.3±10.2)min,两组比较差异有统计学意义(P<0.05);A、B两组分别有4及5例中转开腹,差异无统计学意义(P=0.863);两组术后住院时间及感染性并发症进行统计学处理,差异均无统计学意义(P>0.05)。结论手术时间可随着临床病例的增加而逐步降低,腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术的学习曲线约为33例左右。

Objective To evaluate the outcome of the laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy.Then define the characteristics of the learning curve of this procedure.Methods A prospectively collected database comprising all medical records of the first79consecutive patients underwent laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon was studied.The patients were divided into seven groups(13cases in last group)by operative sequence.Data on patients'demographics,clinical and outcome variables including operative duration,conversion to open surgery,complications,and length of hospital stay were analyzed.The learning curve for the laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was established through the moving average and ANOVA methods.Results Comparing the early with the late experiences(33v.46cases),the surgeon-specific outcomes significantly improved in terms of operating times[(292.7±29.8)vs(215.3±10.2)min,P<0.05],There was four patients converted to open surgery in the early of experiences.the late experiences was five case,it was no statistical significance.significant differences were not shown in the hospitalization period and infectivity complications.Conclusion Operative duration can be reduced with increasing experience of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy,In this study,the learning curve for a laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was about thirty-three cases.