经口腔前庭入路腔镜甲状腺切除术学习曲线的探讨

Discussion on the learning curve of transoral endoscopic thyroidectomy via vestibular approach

目的:研究经口腔前庭入路行腔镜甲状腺切除术的学习曲线。方法:回顾分析2020年6月至2022年5月由同一术者连续施行的110例经口腔前庭入路腔镜甲状腺单侧腺叶切除+中央区淋巴结清扫术患者的临床资料,应用累积和法分析患者手术资料拟合学习曲线,根据学习曲线结果将患者分为两个阶段,技术探索期与成熟期,比较两阶段患者的一般临床资料、术后病理结果、手术时间、术中出血量、手术并发症、术后住院时间等。结果:共纳入110例连续完成手术的患者,学习曲线的转折点在第38例,两阶段患者的一般资料、术后病理结果、病灶数量与大小、甲状腺体积、手术切除的淋巴结数量及阳性淋巴结数量差异无统计学意义(P>0.05);探索期与成熟期手术时间[(204.6±28.5)min vs.(150.9±28.4)min]、术中出血量[10(10,20)mL vs.10(5,10)mL]、术后住院时间[3(2,3)d vs.2(2,3)d]、并发症(4 vs.0)差异均有统计学意义(P<0.05)。结论:经口腔前庭入路腔镜甲状腺切除术具有特定的学习曲线,对于具备丰富开放手术经验而无腔镜手术经验的专科医师,掌握该技术需累计完成的手术例数约为38例。

Objective:To study the learning curve of transoral endoscopic thyroidectomy via vestibular approach.Methods:A retrospective analysis was performed on clinical data of 110 patients who underwent transoral endoscopic thyroidectomy via vestibular approach,which included unilateral thyroidectomy and central lymph node dissection from Jun.2020 to May 2022.The cumulative sum method was used to fit the learning curve after analysis of surgical data.The patients were divided into two stages based on the results of the learning curve,including the technology exploration stage and the mature stage.The general clinical data,postoperative pathological results,operation time,intraoperative blood loss,surgical complications,and postoperative hospital stay of the patients in the two stages were compared.Results:A total of 110 patients who consecutively completed the operation were included,and the turning point of the learning curve was obtained in the 38th case.There was no significant difference in the general information,postoperative pathological results,number and size of lesions,thyroid volume,number of surgically resected lymph nodes,and number of positive lymph nodes between the technology exploration stage and the mature stage(P>0.05).There were significant differences in the average operation time[(204.6±28.5)min vs.(150.9±28.4)min],the median intraoperative blood loss[10(10,20)mL vs.10(5,10)mL],the postoperative hospital stay[3(2,3)d vs.2(2,3)d],and the number of complications(4 vs.0)between the technology exploration stage and the mature stage(P<0.05).Conclusions:Transoral endoscopic thyroidectomy via vestibular approach has a specific learning curve.For specialists who have rich experience in open surgery but no experience in laparoscopic surgery,the cumulative number of operations required to master this technique is about 38 cases.