单一术者经脐单孔腹腔镜肾根治性切除术学习曲线分析及疗效分析

Analysis of learning curve and curative effect of transumbilical single site laparoscopic radical nephrectomy by one single surgeon

目的:探究单一术者行经脐单孔腹腔镜肾根治性切除术的学习曲线分析及疗效分析。方法:回顾性分析南京中医药大学附属医院泌尿外科2019年12月—2021年3月由同一手术医师连续完成的100例行经脐单孔腹腔镜肾根治性切除术患者的临床资料。按手术的先后顺序,将患者分为A、B、C、D、E组(A组即第1阶段组为第1~20例,B组即第2阶段组为第21~40例,C组即第3阶段组为第41~60例,D组即第4阶段组为第61~80例,E组即第5阶段组为第81~100例),对比各组患者手术时间、术中出血量、术中中转率、引流管留置时间、术后并发症、住院时间。结果:各组患者年龄、性别、BMI等比较差异无统计学意义(P>0.05)。与A组患者比较,B组患者手术时间、引流管留置时间和住院时间均明显缩短,术中出血量、中转率和术后并发症发生率明显降低,差异有统计学意义(P<0.05)。B组和C组患者手术时间和术中出血量比较差异有统计学意义(P<0.05)。C组、D组和E组患者手术时间、术中出血量、术中中转率、引流管留置时间、术后并发症、住院时间等指标比较差异均无统计学意义(P>0.05)。结论:经脐单孔腹腔镜肾根治性切除术具有良好的安全性和可行性,随着手术经验的积累,患者手术时间,引流管留置时间和住院时间均显著缩短,术中出血量、中转率和术后并发症发生率均明显降低。学习曲线约为40例。

Objective: To explore the learning curve analysis and curative effect analysis of transumbilical single site laparoscopic radical nephrectomy. Methods: The clinical data of 100 patients with transumbilical single site laparoscopic radical nephrectomy completed by the same surgeon in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2019 to March 2021 were analyzed retrospectively. Patients were divided into 5 groups in chronological order: group A(group in stage 1) included cases 1-20, group B(group in stage 2) included cases 21-40, group C(group in stage 3) included cases 41-60, group D(group in stage 4) included cases 61-80 and group E(group in stage 5) included cases 81-100. The operation time, intraoperative bleeding, intraoperative conversion rate, indwelling time of drainage tube, postoperative complications and hospital stay were compared. Results: There was no significant difference in age, sex or BMI index among the groups(P>0.05). Compared with group A, the operation time, indwelling time of drainage tube and hospital stay in group B were significantly shortened, and the amount of intraoperative bleeding, conversion rate and incidence of postoperative complications were significantly reduced(P<0.05). There was significant difference in operation time and intraoperative bleeding between group B and group C(P<0.05). There was no significant difference in operation time, intraoperative bleeding, intraoperative conversion rate, indwelling time of drainage tube, postoperative complications or hospital stay among group C, group D and group E(P>0.05). Conclusion: Transumbilical single site laparoscopic radical nephrectomy has good safety and feasibility. With the accumulation of surgical experience, the operation time, drainage tube retention time and hospital stay are significantly shortened, and the amount of intraoperative bleeding, conversion rate and postoperative complication rate are significantly reduced. The learning curve was about 40 cases.