腹膜后腹腔镜免缝合肾部分切除术的学习曲线

The learning curve of retroperitoneal laparoscopic sutureless partial nephrectomy

目的:探讨腹膜后腹腔镜免缝合肾部分切除术的学习曲线。方法:回顾分析2020年12月至2021年4月由同一术者及团队连续完成的47例行腹膜后腹腔镜免缝合肾部分切除术的肾肿瘤患者的临床资料,入选病例按手术顺序分为A组(1~12例)、B组(13~24例)、C组(25~36例)与D组(37~47例)四组。对比分析四组一般资料、手术时间、肾脏热缺血时间、出血量、随访结果。结果:四组患者基本信息具有可比性。与A组、B组相比,C组、D组手术时间、阻断时间缩短,差异有统计学意义(P<0.05);但C组、D组间差异无统计学意义(P>0.05)。四组术中出血量差异无统计学意义(P>0.05)。围术期及术后随访均未见明显手术并发症发生。结论:腹膜后腹腔镜免缝合肾部分切除术具有可行性,随着手术经验的增加,手术时间、术中阻断时间可明显缩短,具有一定手术基础的术者学习曲线为23例。

Objective:To explore the learning curve of retroperitoneal laparoscopic sutureless partial nephrectomy.Methods:Retrospective analysis was made on the clinical data of 47 patients who underwent retroperitoneal laparoscopic sutureless partial nephrectomy performed by the same operator and team from Dec.2020 to Apr.2021.All selected cases were divided into group A(1-12 cases),group B(13-24 cases),group C(25-36 cases)and group D(37-47 cases)according to the operation sequence.The general data,operation time,renal warm ischemia time,bleeding volume and follow-up results of the four groups were analyzed and compared.Results:The basic information of patients in the four groups was comparable.The operation time and blocking time of group C and group D were significantly shorter than those of group A and group B(P<0.05),but there was no significant difference between group C and group D(P>0.05).There was no significant difference in intraoperative blood loss among the four groups(P>0.05).There were no obvious complications during perioperative period and postoperative follow-up.Conclusions:Retroperitoneal laparoscopic sutureless partial nephrectomy is feasible.With the increase of surgical experience,the operation time and intraoperative blocking time are significantly shortened.Surgeons with certain surgical basis have stable operation time after the 23rd operation and can basically master the operation.