无充气腋窝入路腔镜甲状腺微小乳头状癌手术的学习曲线

The learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma

目的探讨无充气腋窝入路腔镜甲状腺微小乳头状癌手术的学习曲线。方法回顾性分析笔者所在医院甲状(旁)腺外科2019年11月至2020年9月期间由同一主刀医生最初完成的51例无充气腋窝入路腔镜甲状腺微小乳头状癌手术患者的临床资料。采用累积和(cumulative sum,CUSUM)分析法研究该技术的学习曲线,对CUSUM学习曲线进行最优拟合。比较学习曲线不同阶段的手术时间、术中出血量、清扫淋巴结数目、并发症发生率和术后住院时间的差异。结果CUSUM学习曲线顶点对应的手术例数为18例处,以此为分界将学习曲线划分为学习提高期和熟练掌握期2个阶段。熟练掌握期患者的手术时间短于学习提高期(P<0.05),2个阶段患者的其他资料比较差异无统计学意义(P>0.05)。结论通过CUSUM分析法对无充气腋窝入路腔镜甲状腺微小乳头状癌手术的学习曲线进行精准剖析,表明掌握该技术需累积的手术例数为18例。

Objective To explore the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma.Methods We retrospectively analyzed the clinical data of 51 patients diagnosed with papillary thyroid microcarcinoma who underwent an endoscopic thyroidectomy using a gasless unilateral axillary approach by the same surgeon from November 2019 to September 2020 in the Department of Thyroid and Parathyroid Surgery,West China Hospital,Sichuan University.The cumulative sum(CUSUM)analysis was used to determine the learning curve of the technology,and the CUSUM learning curve was modeled by the best fit.The operative time,intraoperative blood loss,number of lymph nodes dissected,incidence of complications and postoperative hospital stay in different phases of the learning curve were compared.Results The CUSUM fitting curve reached the top at the18 th case.As a cut-off point,the learning curve was divided into two stages:the learning improvement period and the proficiency period.The operative time of patients in the proficiency stage was significantly shorter than that in the learning improvement stage(P<0.05),and there were no statistically significant differences in other data of patients in the two stages(P>0.05).Conclusion The CUSUM analysis method is used to accurately analyze the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma,indicating that the cumulative number of operations required to master this technique is 18 cases.