经腋窝入路免充气腔镜甲状腺单侧腺叶切除术的学习曲线

The learning curve of gasless endoscopic unilateral thyroid lobectomy via axillary approach

目的:探讨经腋窝入路行免充气腔镜甲状腺单侧腺叶切除术的学习曲线。方法:回顾分析2020年3月至2021年9月由同一术者施行的经腋窝入路免充气腔镜甲状腺单侧腺叶切除术的前52例患者的临床资料,按手术日期采用累积和法分析学习曲线,根据学习曲线的结果将52例患者分为两个阶段,比较两个阶段患者的一般临床资料、手术时间、术中出血量、术后并发症、术后病理诊断等。结果:50例患者顺利完成手术,2例中转开放,根据累积和法学习曲线,曲线的转折点在第19例,以此将学习曲线分为技术探索期与成熟期,两个阶段患者的一般资料、术中出血量、术后并发症、术后病理诊断差异无统计学意义(P>0.05);两个阶段的中位手术时间分别为235(210,305)min与165(145,187.5)min,差异有统计学意义(P<0.05)。结论:经腋窝入路免充气腔镜甲状腺单侧腺叶切除术具有特定的学习曲线,掌握该技术需累计完成的手术例数约为19例。

Objective:To explore the learning curve of gasless endoscopic unilateral thyroid lobectomy via axillary approach.Methods:From Mar.2020 to Sep.2021,the clinical data of the first 52 patients who underwent gasless endoscopic unilateral thyroid l obectomy via axillary approach by the same surgeon were retrospectively analyzed.According to the date of operation,the learning curve was analyzed by the cumulative sum method,and the 52 patients were divided into two stages according to the results of the learning curve.General clinical data,operative time,intraoperative blood loss,postoperative complications and postoperative pathological diagnosis of the two stages were compared.Results:Fifty patients completed gasless endoscopic unilateral thyroid lobectomy via axillary a pproach,2 patients were converted to open surgery.According to the cumulative sum learning curve,the turning point of the curve was in the 19th case,which divided the learning curve into the technical exploration period and the mature period.There was not statistical difference in general clinical data,intraoperative blood loss,postoperative complications,and postoperative pathological diagnosis b etween the two stages(P>0.05).The median operative time of the two stages was 235(210,305)min and 165(145,187.5)min,r espectively,with statistically significant difference(P<0.05).Conclusions:Gasless endoscopic unilateral thyroid lobectomy using a xillary approach has a specific learning curve,the cumulative number of operation required to master this technique is about 19.