机器人辅助胰十二指肠切除术学习曲线及与同期开放手术对比分析

Learning curve analysis on robot assisted pancreatoduodenectomy and comparison with open pancreaticoduodenectomy in the initial period

目的:分析机器人辅助胰十二指肠切除术(Robot-assisted pancreaticoduodenectomy,RAPD)的学习曲线(Learning curve,LC),并与同期开放胰十二指肠切除术(Open pancreaticoduodenectomy,OPD)比较,分析RAPD在初始学习阶段的安全性及可行性。方法:回顾性分析2015年10月~2019年5月单一手术组所完成的全部RAPD和OPD的病例,利用累积求和法(Cumulative sum,CUSUM)分析其学习曲线,同时提取两组病例的临床病例资料进行比较。结果:共入组30例RAPD和48例OPD,两组间基本资料无显著差异。与OPD组相比,RAPD组手术时间明显延长[(423.7±137.6)min Vs(228.8±45)min,P<0.001)],医疗费用明显升高[(185700±54500)元Vs(120600±41700)元,P<0.001)]。此外,与OPD组相比,RAPD组平均淋巴结检出数减少[(8.7±4.9)枚Vs(14.3±7.6)枚,P=0.007)]。Clavein-Dindo III级以上并发症、术后90d死亡率和再入院率比较,两组间无显著统计学差异。CUSUM分析显示,RAPD手术时间在第8例后出现显著下降。结论:RAPD的学习曲线可在30例以前完成,在学习曲线初始阶段RAPD是安全可行的。

Objective:To analyze the learning curve(LC)of robot assisted pancreaticoduodenectomy(RAPD)and compare the safety and feasibility of RAPD during the initial period with open pancreaticoduodenectomy(OPD).Methods:78 patients underwent RAPD or OPD from October 2015 to May 2019 in the Second Xiangya Hospital were retrospectively analyzed.30 patients were selected into RAPD group and 48 into OPD group.The learning curve was analyzed with cumulative sum(CUSUM)and the clinicopathological data of the two groups were collected for comparison.Results:No obvious differences were found on general information of two groups.Compared with OPD,RAPD requires longer operative time[(423.7±137.6)min Vs(228.8±45)min,P<0.001].RAPD also needs higher cost comparing with OPD[(185700±54500)CNY Vs(120600±41700)CNY,P<0.001].However,compared with the OPD group,the RAPD group found less number of lymph nodes harvested in malignant cases[(8.7±4.9 Vs 14.3±7.6,P=0.007].No statistically significant differences were observed between the two groups on incidence of grade III and above complications by Clavien–Dindo classification system,90-day postoperative mortality and readmission rate.The CUSUM graph shows that the operation time significantly decreased after the 8th case.Conclusion:The LC of RAPD may be finished in 30 cases,it is safe and feasible to perform RAPD in the initial period of LC.