单孔腹腔镜完全腹膜外腹股沟疝修补术学习曲线的影响因素分析

Analysis of factors affecting the learning curve of single-incision laparoscopic totally extraperitoneal herniorrhaphy

目的:探讨影响单孔腹腔镜完全腹膜外疝修补术(SIL-TEP)学习曲线的相关因素。方法:回顾分析2019年11月至2021年11月四所医院疝中心单一主刀医师与固定助手行SIL-TEP的临床资料,通过累积和分析法,根据每个中心的学习曲线情况,结合各中心主刀医师的学习背景,分析影响SIL-TEP学习曲线的相关因素。结果:四所医院单一主刀医师度过SIL-TEP学习曲线的例数分别为18例、13例、10例、10例,各组跨越学习曲线前后两阶段的年龄、BMI、疼痛评分、血清肿、中转率等差异均无统计学意义(P>0.05),各组均无复发、感染病例,各组跨越学习曲线前后两阶段手术时间差异有统计学意义(P<0.05)。结论:SIL-TEP学习曲线可控,在具备丰富三孔腹腔镜疝修补经验、固定手术团队、特定指导带教老师、较强学习及复盘能力、短期连续集中开展该手术等条件下跨越学习曲线需10~18例。

Objective:To investigate the factors affecting the learning curve of single-incision laparoscopic totally extraperitoneal herniorrhaphy(SIL-TEP).Methods:All SIL-TEP procedures performed by the same chief surgeons and the same assistants in the four hernia centers from Nov.2019 to Nov.2021 were retrospectively analyzed to evaluate the clinical outcomes.Based on the learning curve of each center and the different learning backgrounds of the surgeons,the relevant factors that affected the SIL-TEP learning curve were analyzed through cumulative sum analysis method.Results:The number of cases in which the chief surgeons spent the SIL-TEP learning curve in the four centers was 18,13,10,and 10.There was no significant difference in age,BMI,pain score,seroma,and conversion rate of two stages of learning curve before and after the turning point in the four groups(P>0.05),and no postoperative recurrence and infection occurred in all patients.The operative time of two stages of learning curve before and after the turning point was statistically significant in each group(P<0.05).Conclusions:The SIL-TEP learning curve is controllable.The number of learning curve cases is about 10-18 under the conditions of rich experience in three-port laparoscopic hernia repair,fixed surgical team,specific guidance teachers,strong capacity of learning and debriefing,and short-term continuous focus on this procedure.