目标性后腹腔镜下肾上腺病损切除术的学习曲线

The learning curve of goal-oriented retroperitoneoscopic adrenal lesion resection

目的以手术时间、术中出血量为观察指标分析目标性后腹腔镜下肾上腺病损切除术的学习曲线。方法回顾性分析连云港市第一人民医院泌尿科2019年1月至2022年1月由同一团队完成的60例目标性后腹腔镜下肾上腺病损切除术患者的临床资料,按时间顺序平均分为四组:A组(病例1~15)、B组(病例16~30)、C组(病例31~45)、D组(病例46~60)。统计每组手术的手术时间、术中出血量、切口长度及术后住院时间,比较组间差异。结果通过统计分析可见,随着手术例数增加,手术时间、术中出血量呈下降趋势,进行两两比较,A组的手术时间和术中出血量与B、C、D三组有明显差异(P<0.05),B组的手术时间和术中出血量与C、D两组有明显差异(P<0.05),C组的手术时间和术中出血量与D组比较,无显著性差异(P>0.05)。四组的切口长度和术后住院时间无显著性差异(P>0.05)。结论对于具有丰富后腹腔镜肾上腺病损切除术经验的泌尿外科医师,30例左右是目标性后腹腔镜肾上腺病损切除术的学习曲线。

Objective To evaluate the learning curve of goal-oriented retroperitoneoscopic adrenal lesion resection measured by operative length and intraoperative blood loss.Methods The clinical data of 60 patients underwent Goal-oriented retroperitoneoscopic adrenal lesion resection completed by the same group of surgeons from January 2019 to January 2021 were retrospectively analyzed.All the cases were divided into group A(case 1 to 15),group B(case 16 to 30),group C(case 31 to 45),group D(case 46 to 60).Operative length,intraoperative blood loss,incision length and postoperative hospital stay were analyzed and differences between groups were compared.Results By the statistical analysis,the operative length and intraoperative blood loss was decreasing with the increase of cases.By multiple comparison,differences of the operative length and intraoperative blood loss between group A and group B,C,D were significant(P<0.05).Differences of the operative length and intraoperative blood loss between group B and group C,D were significant(P<0.05).There was no significant difference differences of the operative length and intraoperative blood loss between group C and group D(P>0.05).There were no statistical significant difference differences of incision length and postoperative hospital stay between the four groups(P>0.05).Conclusion For the urologist with rich retroperitoneoscopic adrenal lesion resection experience,the learning curve of the Goal-oriented retroperitoneoscopic adrenal lesion resection is the accumulation 30 cases of experience.