腹腔镜经腹腹膜前腹股沟疝修补术的学习曲线

Learning curve of laparoscopic transabdominal preperitoneal inguinal hernia repair

目的:探讨具有熟练腹腔镜基础操作技术的医师开展腹腔镜经腹腹膜前疝修补术的学习曲线。方法:回顾分析2016年1月至2017年9月由同一术者完成的60例腹腔镜经腹腹膜前疝修补术的临床资料,不包括双侧及复发性腹股沟疝。根据开展手术的顺序分为6组,每组10例,比较各组手术时间、中转开腹情况、术中出血量、术中术后并发症、术后住院时间等指标。结果:6组患者年龄、中转开腹率、术中出血量、术中术后并发症及术后住院时间差异无统计学意义,从第1组到第6组手术时间逐渐缩短:(120.7±21.4)min、(110.5±16.5)min、(101.2±10.3)min、(93.5±10.2)min、(79.9±9.3)min、(69.7±8.5)min。前4组手术时间差异无统计学意义(P>0.05),第5组手术时间短于前四组,与第4组相比差异有统计学意义(P<0.01),与第6组相比差异无统计学意义(P=0.07)。结论:对于有熟练腹腔镜基本操作技术的医师而言,腹腔镜经腹腹膜前疝修补术的学习曲线约为40例。

Objective:To investigate the learning curve of laparoscopic transabdominal preperitoneal(TAPP) inguinal hernia repair in experienced laparoscopic surgeons.Methods:Clinical data of 60 TAPPs performed by the same surgeon from Jan.2016 to Sep.2017 were reviewed excluding bilateral inguinal hernia and recurrent inguinal hernia.Patients were divided into 6 groups according to the time sequence with 10 in each group.The operative time,conversion to open surgery,bleeding volume,intraoperative and postoperative complications,hospital stay were compared among groups.Results:There was no significant difference in age,conversion to open surgery,bleeding volume,intraoperative and postoperative complications,hospital stay among the 6 groups,and the operative time was gradually shortened from group 1 to 6:(120.7±21.4)min,(110.5±16.5)min,(101.2±10.3)min,(93.5±10.2)min,(79.9±9.3)min,(69.7±8.5)min.The operative time of the first 4 groups was not statistically different(P>0.05).But the operative time of group 5 was significantly shorter than that of the former four groups,and the difference between group 5 and group 4 was statistically significant(P<0.01).The operative time of group 5 and group 6 was not statistically significantly different(P=0.07).Conclusions:The learning curve of TAPP in an experienced surgeon is approximately 40 cases.