腹腔镜肝左外叶切除术的学习曲线

Learning curve in laparoscopic left lateral hepatic sectionectomy

目的:研究腹腔镜肝左外叶切除术的学习曲线。方法:回顾性分析2015年2月至2022年5月北部战区总医院连续62例接受同一术者独立实施的肝左外叶切除术的患者临床资料,其中男性22例,女性40例,年龄(50.7±11.7)岁。使用累积和检验绘制并分析学习曲线,对学习成长阶段和熟练掌握阶段患者的一般资料、手术及术后指标进行全面比较。结果:62例患者的手术时间(172.9±70.1)min,术中出血量100(50,200)ml,中转开腹2例(3.2%),术后并发症Clavien-Dindo分级Ⅰ级20例(32.3%),Ⅱ级1例(1.6%),Ⅲb级1例(1.6%)。累积和检验得出当患者例数达到20例时拟合学习曲线达最高点,以此分为学习成长阶段(第1-20例)和熟练掌握阶段(第21-62例)。与学习成长阶段比较,熟练掌握阶段的患者年龄选择更为宽泛[(52.9±11.0)岁比(46.1±11.9)岁],手术时间[(146.8±55.6)min比(227.9±66.7)min]、引流管拔除时间[4(3,5)d比6(4,7)d]、术后住院时间[5(5,7)d比6.5(4,9)d]更短,差异均具有统计学意义(均P<0.05)。结论:在推广腹腔镜肝左外叶切除术时,术者需经历20例左右的学习成长周期后,方可较为熟练掌握该术式。

Objective To study the learning curve in laparoscopic left lateral hepatic sectionectomy.Methods The clinical data of 62 consecutive patients who underwent left lateral hepatic sectionectomy by a single operator from February 2015 to May 2022 in General Hospital of Northern Theater Command were retrospectively analyzed.There were 22 males and 40 females,with mean±s.d.of(50.7±11.7)years.The learning curve was depicted and evaluated by using the cumulative summation test.The general information,operation and postoperative indicators of the growth level group and the master level group were compared.Results The average operation time of the 62 consecutive subjects was(172.9±70.1)minutes.Intraoperative blood loss was 100(50,200)ml.Two patients were converted to open hepatectomy.Clavien-Dindo grade I postoperative complications occurred in 20 patients(32.3%),with gradeⅡin 1 patient(1.6%)and gradeⅢb in another patient(1.6%).The learning curve reached its highest point on the 20th patient by using the cumulative summation test.The study subjects were then assigned into the growth level group(patient 1-20)and the master level group(patient 21-62).The master level group had a significantly wider spread of patient age[(52.9±11.0)years vs(46.1±11.9)years],decreased operation time[(146.8±55.6)min vs(227.9±66.7)min],shortened drainage tube removal time[4(3,5)d vs 6(4,7)d]and decreased postoperative hospital stay[5(5,7)d vs 6.5(4,9)d](all P<0.05)when compared with the growth level group.Conclusion Left lateral hepatic sectionectomy was safe and feasible,and a single operator went through a learning curve of 20 patients before he/she could master the operation more proficiently.