3D全胸腔镜不停跳房间隔缺损修补术CUSUM学习曲线分析

Learning curve of 3D total thoracoscopic surgery for atrial septal defect

目的探讨3D全胸腔镜不停跳房间隔缺损(ASD)修补术的学习曲线及安全性。方法 ASD患者206例,完成3D全胸腔镜ASD修补及三尖瓣成形术44例(腔镜组)。累积和(CUSUM)法确定3D胸腔镜ASD修补术的学习曲线。并与传统开胸手术(开胸组)行倾向性评分匹配(PSM),分析腔镜组学习期间手术的安全性。结果 CUSUM学习曲线显示手术失败率、手术时间、体外循环时间、术后并发症发生率分别在第34、21、29及39例患者后低于可接受水平。匹配后两组术前特征不存在系统差异。腔镜组体外循环时间长于开胸组(P=0.000);手术时间、呼吸机辅助时间、ICU住院时间、术后并发症及总住院费用两组比较差异无统计学意义(P>0.05)。腔镜组术后引流量明显少于开胸组(P=0.000)。结论 3D胸腔镜不停跳ASD修补术使手术更简化,更安全,不增加术后并发症及住院费用,并能在39例后快速跨越学习曲线。

Objective To evaluate the operation security and learning curve of 3D total thoracoscopic atrial septal defect repair.Methods From January 2015 to August 2017,206 ASD patients were enrolled in this study.3D thoracoscopic ASD repair concomitant tricuspid valve annuloplasty in 44 cases(observation group)while in the same period,conventional thoracotomy(control group)were treated with propensity score matching,and determine the learning curve of 3D thoracoscopic ASD repair technique by the CUSUM analysis method,and analyzed thoracoscopic surgery the clinical effect and safety during the period of learning.Results The CUSUM learning curve showed that operative failure rate,operative time,cardiopulmonary bypass time and postoperative complications were 34th,21st,29th and 39th patients below acceptable level respectively.There was no significant difference between the two groups of preoperative characteristics after matching.Cardiopulmonary bypass time in the observation group was significantly longer than that in the control group(P=0.000).There was no significant difference among the operative time,mechanical ventilation time,ICU monitoring time,postoperative complications and total hospitalization expenses between the two groups(P>0.05).The postoperative drainage of the observation group was significantly less than that in the control group(P=0.000).Conclusions 3D thoracoscopic surgery for the repair of atrial septal defect can make endoscopic surgery more simplified and safely.The learning curve stage does not increase surgical complications and hospitalization costs,and can span the learning curve after 39 cases.