单中心经脐单孔腹腔镜全子宫切除术的学习曲线分析

Learning Curve Analysis of Transumbilical Laparoendoscopic Single-site Surgery of Total Hysterectomy in One Medical Center

目的探讨单中心采用单孔入路平台完成经脐单孔腹腔镜全子宫切除术的学习曲线。方法回顾性分析我院单一主刀医生2020年5月~2021年8月连续施行66例单孔腹腔镜子宫全切术的临床资料,通过累积求和分析法(cumulative summation,CUSUM),计算手术时间(A1)、术中出血量(A2)、术后并发症(A3)的累积求和值,即每个手术的量化值:Σ=A1+A2+A3。以Σ为基础绘制学习曲线并进行多项式曲线拟合:y=6×10^(-7)x^(4)+0.0002x^(3)-0.0384x^(2)+1.4742x+0.0864,决定系数R^(2)=0.9874,当曲线斜率k自正值转变为负值时,即跨越学习曲线和拟合曲线公式。结果所有患者手术均顺利进行,无中转多孔及开腹手术。手术时间(130.3±40.5)min(85~250 min);出血量(106.2±82.9)ml(20~400 ml)。对拟合函数y求导y′=2.4×10^(-6)x^(3)+0.0006x^(2)-0.0768x+1.4742,每例手术的k值对应拟合函数的导数值,25例手术后CUSUM学习曲线k值为负。结论依据研究获得的学习曲线,有30例以上多孔腹腔镜全子宫切除术经验的医生经过25例经脐单孔腹腔镜全子宫切除术可以跨越学习曲线。

Objective To investigate the learning curve of transumbilical laparoendoscopic single-site surgery(TU-LESS)of total hysterectomy in one medical center.Methods Clinical data of 66 patients who received total hysterectomy from May 2020 to August 2021 in our hospital were retrospectively analyzed.The learning curve of TU-LESS of total hysterectomy was drawn by using cumulative summation(CUSUM).The cumulative sum of operative time(A1),blood loss(A2)and postoperative complications(A3)was calculated,that was,the quantitative value of each operation:Σ=A1+A2+A3.The learning curve was drawn and the polynomial curve was fitted based on theΣ:y=6×10^(-7) x^( 4)+0.0002x ^(3)-0.0384x ^(2)+1.4742x+0.0864,the fitting coefficient R^( 2)=0.9874.When the curve slope k changed from a positive value to a negative value,the learning curve and fitting curve formula were inflected.Results All the operations were successfully completed without conversion to multi-port or open surgery.The operative time was(130.3±40.5)min(range,85-250 min),and the blood loss was(106.2±82.9)ml(range,20-400 ml).The derivative value of the fitting function y was calculateed y′=2.4×10^(-6)x ^(3)+0.0006x ^(2)-0.0768x+1.4742.The k-value of each operation corresponded to the derivative value of the fitting function.The k-value of CUSUM learning curve after 25 operations was negative.Conclusion The learning curve of TU-LESS of total hysterectomy shows that after 25 cases of operation,the surgeon with experience of more than 30 cases of multi-trocar laparoscopic total hysterectomy can perform quickly and safely.