单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌的学习曲线

On Learning Curve of Single Utility Port Video-assisted Thoracoscopic Segmentectomy for Early-stage Non-small Cell Lung Cancer

目的探讨单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的学习曲线。方法回顾性分析2016年1月~2021年8月我院同一手术团队单操作孔胸腔镜肺段切除治疗132例早期NSCLC的临床资料,使用多维累积和(cumulative sum,CUSUM)方法分析其学习曲线,并比较学习曲线不同阶段的一般资料及手术指标差异。结果学习曲线最佳拟合曲线为四次方曲线,拟合优度系数R^(2)=0.9801,拟合方程为:y=-4.468+1.312x+1.377e^(-3)x^(2)-2.33e^(-4)x^(3)+1.131e^(-6)x^(4),CUSUM曲线在手术例数为58时其斜率从正值变为负值,故以58例为界将学习曲线分为学习提高阶段和熟练掌握阶段。与学习提高阶段相比,熟练掌握阶段手术时间及术后住院时间均缩短(P<0.05),围术期并发症发生率降低(P<0.05),术中出血量及被动中转率虽呈下降趋势,但差异无统计学意义(P>0.05),两阶段清扫/采样淋巴结组数及个数差异亦无统计学意义(P>0.05)。结论对于熟练掌握单操作孔胸腔镜肺叶切除的胸外科医生来说,开展单操作孔胸腔镜肺段切除的学习曲线并不长,经过58例手术就可以熟练开展。

Objective To explore the learning curve of single utility port video-assisted thoracoscopic segmentectomy for early-stage non-small cell lung cancer(NSCLC).Methods Clinical data of 132 patients with early-stage NSCLC who received single utility port video-assisted thoracoscopic segmentectomy by a same surgical team from January 2016 to August 2021 were analyzed retrospectively.Multidimensional cumulative summation(CUSUM)analysis was performed to evaluate the learning curve.Then the difference of the general data and surgical indexes of the two stages of the learning curve was compared.Results The learning curve was best modeled as a four-order polynomial and the R^(2) value was 0.9801,with the equation of y=-4.468+1.312x+1.377e^(-3)x^(2)-2.33e^(-4)x^(3)+1.131e^(-6)x^(4).The CUSUM curve slope turned from positive to negative when the number of cases exceeded 58,therefore taking 58 cases as the cut-off point of the learning curve between the learning stage and mastery stage.As compared with the learning stage,the operative time and postoperative hospital stay were significantly shortened and the rate of perioperative complications was significantly reduced at the mastery stage(all P<0.05).There was a declining trend but no significant difference in the blood loss and rate of passive conversion(all P>0.05).There was no difference in the dissected number of lymph nodes and lymph node stations(all P>0.05).Conclusion For experienced thoracic surgeons,the learning curve of single utility port video-assisted thoracoscopic segmentectomy is not long,which can be carried out skillfully after 58 operations.