单中心单人机器人辅助腹腔镜子宫内膜癌分期手术学习曲线及临床分析

Clinical efficacy and learning curve of robot-assisted laparoscopic surgery for endometrial cancer by the same surgeon:a single-center report

目的:探讨机器人辅助腹腔镜下子宫内膜癌分期手术的学习曲线及临床疗效。方法:回顾性分析2019年12月—2020年12月济宁医学院附属医院妇科由同一术者完成的机器人辅助腹腔镜下子宫内膜癌分期手术40例患者的病例资料。使用累积和(Cumulative Sum,CUSUM)法分析学习曲线,并对不同阶段的手术时间、术中出血量、淋巴结切除个数、术后住院时间、手术并发症发生率等指标进行比较。结果:CUSUM学习曲线的最佳拟合方程为y=32.330+25.063x-0.637x^(2)-0.0000362x^(3),该模型拟合优度R^(2)=0.805,CUSUM曲线在手术例数达20例时达峰值,以此为界将学习曲线划分为两个阶段:积累阶段(A阶段)和熟练阶段(B阶段)。B阶段手术时间、出血量、住院时间均明显优于A阶段(P<0.05)。但A、B两阶段盆腔及腹主动脉旁淋巴结切除数、手术并发症发生率比较,差异无统计学意义(P>0.05)。结论:机器人辅助腹腔镜下子宫内膜癌分期手术是一种可选择的手术方式。实施机器人辅助腹腔镜下子宫内膜癌分期手术的医生,累积手术例数为20例可熟练掌握这项技术。

Objective:To explore the clinical efficacy and learning curve of Da Vinci robotic surgical system in the treatment of endometrial cancer.Methods:Clinical data of 40 patients with endometrial cancer who underwent robot-assisted laparoscopic surgery for endometrial cancer by the same team from December 2019 to December 2020 were retrospectively analyzed.All surgeries were performed by the same surgeon.The cumulative sum analysis(CUSUM)was used to study the learning curve of Da Vinci robotic surgical system in treating endometrial cancer.The operating time,blood loss,number of dissected lymph nodes,postoperative hospital stay,incidence rate of postoperative complications were analysed.Results:The best fitted equation of CUSUM learning curve was y=32.330+25.063x-0.637x^(2)-0.0000362x^(3),with goodness of fit R^(2)=0.805.The peak value of CUSUM curve was the 20th case,and the learning curve were divided into learning stage(stage A)and mastery stage(stage B)with the cut-off point of 20 cases.The operating time,blood loss,postoperative hospital stay in stage B was significantly better than that in the stage A(P<0.05).The two stages were similar in terms of the number of dissected pelvic and para-aortic lymph node and incidence rate of postoperative complications(P>0.05).Conclusion:Robot-assisted laparoscopic surgery is an alternative surgical method for endometrial cancer.The learning curve of robot-assisted laparoscopic surgery for endometrial cancer is around 20 cases.