完全腹腔镜右半结肠切除术的学习曲线分析

Learning curve analysis of totally laparoscopic right colectomy

目的:分析单一治疗组行完全腹腔镜右半结肠切除术的学习曲线。方法:回顾分析2017年2月至2018年12月同一治疗组为72例结肠癌患者行完全腹腔镜右半结肠切除术的临床资料,采用累积求和法及最佳拟合曲线分析其学习曲线,对比度过学习曲线前后的一般资料、手术情况、术后恢复情况、围手术期并发症发生率、临床病理特征等。结果:72例患者均顺利完成完全腹腔镜右半结肠切除术,无中转开腹及围手术期死亡病例。术后3例(4.2%)发生腹部切口感染,手术时间平均(158.0±31.6)min。完全腹腔镜右半结肠切除术的学习曲线可分为两个阶段,26例后可认为已度过学习曲线。手术时间由(188.7±29.7)min降至(140.7±15.3)min(P<0.001),术中出血量由(70.0±43.6)mL降至(43.5±18.3)mL(P=0.001),术后住院时间由(7.0±1.8)d降至(5.5±1.0)d(P<0.001)。结论:完全腹腔镜右半结肠切除术学习过程安全。经过约26例的手术后可顺利达到熟练掌握的程度,适合具有丰富腹腔镜结肠癌根治术经验的团队开展。

Objective:To analyze the learning curve of totally laparoscopic right colectomy completed by the same surgical team.Methods:From Feb.2017 to Dec.2018,72 patients with right colon cancer were treated by totally laparoscopic right colectomy.The learning curve was evaluated using the cumulative sum analysis and the best fitting curve method.According to the minimum number of surgeries required to cross the learning curve,the clinicopathological features,operative characteristics,postoperative recovery and perioperative complications rate were compared between the two study periods.Results:All the 72 patients underwent totally laparoscopic right colectomy without conversion to open surgery or perioperative death.A total of 3 cases(4.2%)had postoperative abdominal incision infection.Average operative time was(158.0±31.6)min.According to cumulative summation method,totally laparoscopic right colectomy could be divided into 2 learning phases,26 cases were considered to have passed the learning curve.The average operation time decreased from(188.7±29.7)min to(140.7±15.3)min(P<0.001),intraoperative blood loss decreased from(70.0±43.6)mL to(43.5±18.3)mL(P=0.001),and postoperative hospital stay decreased from(7.0±1.8)d to(5.5±1.0)d(P<0.001).Conclusions:It is safe to study totally laparoscopic right colectomy.The cumulative sum learning curve of totally laparoscopic right colectomy could be divided into two periods with 26 cases or more considered to master the technique.More surgical teams which have experience of laparoscopic colon tumor excision can carry this technique.