机器人辅助腹腔镜下前列腺癌根治术的学习曲线研究

The surgical learning curve of robotic-assisted laparoscopic radical prostatectomy

目的总结机器人辅助腹腔镜下前列腺癌根治术(RALP)的学习曲线。方法回顾性收集2015年5月至2017年5月由我科两名术者独立完成的前80例RALP患者资料,按手术时间先后顺序,分为A组(第1~20例)、B组(第21~40例)、C组(第41~60例)、D组(第61~80例)。四组患者术前年龄44~78岁,平均67岁。至我院就诊时PSA 0.48~247.00μg/L,中位PSA12.27μg/L,术前临床T1期14例,T2期47例,T3期及以上共19例。以手术时间、术中失血、术后拔尿管时间、术后住院时间等为衡量指标。结果四组均成功完成手术,无中转开放手术。手术时间130~480 min,平均240 min;术中出血10~1 500 ml,中位数值100 ml;术后拔除导尿管时间7~36 d,平均16 d;术后住院时间4~22 d,平均10 d。后三组患者的手术时间和术后拔出导尿管时间均较A组明显缩短(P<0.05);另外,经过A组前20例手术积累,后40例患者中高危组人数逐渐增多,手术时间及术中出血也呈现进入学习曲线平台期。结论 RALP具有明显的学习曲线。在渡过第一个学习平台后,术者可根据自身情况逐步纳入手术难度较大的患者。

Objective To investigate the surgical learning curve of robotic-assisted laparoscopic radical prostatectomy(RALP).Methods The data of the first 80 RALP patients,who were admitted to our hospital between May 2015 and May 2017.All of the operations were done by two surgeons independently.According to the operation sequence,the 80 cases were divided into four groups,including Group A(1st to 20th),Group B(21st to 40th),Group C(41st to 60th)and Group D(61st to 80th).The mean age of patients was 67 years(range 44 to 78 years),median serum PSA level was 12.27μg/L(range 0.48 to 247.00μg/L).The cases staged T1,T2 or higher were 14,47 and 19,respectively.The operative time,intraoperative hemorrhage volume,postoperative hospital stay and catheterization time were statistically analyzed.Results Surgical procedures were successfully completed in all groups.No patient was turned to open surgery.The mean operative time was 240 min(range 130 to 480 min).The median intraoperative hemorrhage volume was 100 ml(range 10 to 1500 ml).The mean catheterization time was 16.2 days(range 7 to 36 days).Postoperative of hospital stay averaged 10.3 days(range 4 to 22 days).Comparing with Group A,the operative and catheterization time were obviously decreased in the last three groups(P<0.05).Moreover,the operative time and the intraoperative hemorrhage volume also reached the plateau of learning curve after 20 cases.More and more high risk patients in last 40 cases.Conclusion There is an obvious learning curve in the study process of RALP.After reaching the plateau of the learning curve,surgeons could generally try to conduct operations with more difficulty.