经阴道自然腔道腹腔镜卵巢囊肿剥除术的学习曲线

The learning curve of transvaginal natural orifice transluminal endoscopic surgery of ovarian cystectomy

目的探讨经阴道自然腔道腹腔镜(transvaginal natural orifice transluminal endoscopic surgery,vNOTES)卵巢囊肿剥除术的学习曲线。方法回顾性分析同济大学附属第一妇婴保健院2017年9月至2020年12月由同一位术者施行的79例vNOTES卵巢囊肿剥除术的相关临床资料,利用累积求和法分析其学习曲线,根据学习曲线分为两个阶段,对比学习曲线前后两个阶段的手术时间、术中出血量、手术并发症、术后疼痛视觉模拟评分(visual analogue scale,VAS)、术后首次排气时间、术后住院时间。结果3例阴道后穹窿入路困难而中转经腹腹腔镜手术操作、1例卵巢创面出血活跃而中转至经腹腹腔镜手术操作,其他75例均完成vNOTES。本研究讨论75例病例的学习曲线。平均手术时间为63.63 min,利用累积求和法计算得出28例手术后的手术时间趋于稳定,故将学习曲线分为两个阶段,第1~28例为第一阶段、第29~75例为第二阶段。第一阶段及第二阶段的手术时间分别为(88.42±6.97)min和(48.85±2.46)min、术中出血量分别为(58.42±10.73)ml和(25.42±3.48)ml、VAS分别为(1.21±0.15)分和(0.76±0.11)分、术后首次排气时间分别为(22.01±1.27)h和(14.93±0.26)h,两个阶段间比较,差异有统计学意义(P<0.05);术后住院时间分别为(3.37±0.11)d和(3.14±0.18)d,两个阶段间比较,差异无统计学意义(P>0.05);无手术相关并发症。结论对于有一定单孔腹腔镜及阴式手术操作基础的医师,完成28例vNOTES卵巢囊肿剥除术后,手术时间趋于稳定。

Objective To explore the learning curve of transvaginal natural orifice transluminal endoscopic surgery of ovarian cystectomy.Method From Sep.2017 to Dec.2020,79 cases of transvaginal natural orifice transluminal endoscopic surgery of ovarian cystectomy were performed by the same surgeon in Shanghai First Maternity and Infant Health Hospital.The learning curve was analyzed by cumulative summation method.It was divided into two stages according to the learning curve.The operation time,intraoperative blood loss,postoperative complications,postoperative visual analogue scale(VAS)pain score,the first exhausting time,postoperative hospital stay were compared between the two stages.ResultsThree cases were converted to conventional laparoscopy due to the difficulty of posterior vaginal fornix approach.One case was converted to conventional laparoscopy due to active ovarian wound bleeding.The remaining 75 cases were successfully completed by transvaginal natural orifice transluminal endoscopic surgery.Therefore,this study discussed the learning curve of 75 cases.The average operation time was 63.63 minutes.The cumulative summation method was used to calculate the operation time and the operation time tended to be stable after 28 cases.Therefore,the learning curve was divided into two stages:the first stage was from 1 to 28 cases,and the second stage was from 29 to 75 cases.The operation time of the first and second stage was(88.42±6.97)min,(48.85±2.46)min.The blood loss was(58.42±10.73)ml,(25.42±3.48)ml.The VAS was(1.21±0.15),(0.76±0.11).The first exhaust time was(22.01±1.27)h,(14.93±0.26)h.There were significant differences between the two groups(P<0.05).The postoperative hospital stay was(3.37±0.11)d,(3.14±0.18)d(P>0.05).Conclusions Doctors who have certain experiences of single port laparoscopic and vaginal operation,their operation time tends to be stable after 28 cases of transvaginal natural orifice transluminal endoscopic surgery of ovarian cystectomy.