胸乳入路腔镜甲状腺手术学习曲线及经验体会

Experience and learning curve of endoscopic thyroidectomy via breast

目的探索胸乳入路腔镜甲状腺手术学习曲线,总结无腔镜经验甲状腺专科主任医师学习腔镜甲状腺手术的经验体会。方法回顾性分析该院2014年7月-2019年3月由同一组手术医师完成的胸乳入路腔镜甲状腺手术51例,按手术先后顺序,将所有患者分为A、B、C、D和E 5组。统计患者的一般临床资料和手术相关资料,采用移动平均线法分析学习曲线。结果A组手术时间与B、C、D和E组比较,差异均有统计学意义,B、C、D和E组各组间手术时间比较,差异均无统计学意义。共6例患者出现手术并发症,其中A组3例。结论对于无腔镜经验的甲状腺专科主任医师,胸乳入路腔镜甲状腺手术的学习曲线至少为10例,若将腔镜辅助小切口甲状腺手术计入其中,则学习曲线至少应为21例。

Objective To explore the learning curve of endoscopic thyroidectomy via breast approach and summarize the experience of chief surgeon who had never performed any endoscopic surgery before.Methods A retrospective analysis was made on the base of 51 cases of endoscopic thyroidectomy via breast approach,which were performed by the same group of surgeons from July 2014 to March 2019.All of the cases were divided into five groups:A,B,C,D and E according to the sequence.Statistical indicators include general indicators and surgical related ones.Learning curve was analyzed by moving average method.Results The operation time of group A was significantly different from that of group B,C,D and E,but there were no differences among groups of B,C,D and E.There were 6 cases of surgical injuries,3 cases of which occurred in group A.The learning curve was made according to the operation time.The results indicated that only one surgeon completed 10 cases of endoscopic thyroidectomy independently could he enter a stable stage.Conclusion In order to get through the learning curve and enter a stable period,a chief physician,who has never performed any endoscopic surgery,needs to complete 10 cases of endoscopic thyroidectomy via breast approach.If modified video-assisted thyroidectomy was included,the learning curve was at least 21 cases.