经口腔前庭入路单线悬吊吸引杆辅助混合建腔甲状腺手术经验和学习曲线

Experience and learning curve of single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach

目的探讨经口腔前庭人路单线悬吊吸引杆辅助混合建腔甲状腺手术经验和学习曲线。方法回顾性分析川北医学院附属医院甲状腺乳腺外科2019年9月至2021年12月完成的138例经口腔前庭人路单线悬吊吸引杆辅助混合建腔甲状腺手术患者临床病例数据。采用累积和法(cumulative sum,CUSUM)及最佳拟合曲线分析比较学习曲线不同阶段手术时间、术中出血量、清扫中央区淋巴结数目及术后相关并发症等各指标的差异。结果138例全部实施经口腔前庭人路单线悬吊吸引杆辅助混合建腔甲状腺手术,其中1例因肿块较大术中出血而中转开刀。男14例,女124例,年龄(36.07±8.49)岁,范围20~55岁,肿瘤(7.74±6.49)mm,范围2.4~50.0mm,接受甲状腺次全切除术5例,单侧腺叶切除+中央区淋巴结清扫术129例,双侧甲状腺近全切除+中央区淋巴结清扫术4例。CUSUM学习曲线顶点对应的手术例数为45例,由此为界将学习曲线分为学习提高期(1~45例)和熟练掌握期(46~138例)2个阶段。熟练掌握期的手术时间、术中出血量、术后住院时间、下颊麻木感均低于学习训练期(P<0.05),清扫中央区淋巴结数目多于学习提高期(P<0.05),而2个阶段的其他指标差异无统计学意义(P>0.05)。结论经口腔前庭人路单线悬吊吸引杆辅助混合建腔甲状腺手术有临床应用价值,值得推广,掌握该项技术需积累的手术例数为45例。

Objective To explore the experience and learning curve of single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach.Methods Clinical data of 138 pa-tients undergoing single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via oral vestibu-lar approach from Sep.2019 to Dec.2021 in the Department of Thyroid and Breast Surgery of Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed.The cumulative sum(CUSUM)method and best-fit curve analysis were used to compare the differences in each index such as operative time,intraoperative bleeding,number of lymph nodes cleared in the central region and postoperative related complications at various stages of the learning curve.Results All 138 patients underwent single-line suspension rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach,and one patient was converted to open surgery due to large intraop-erative bleeding in the mass.There were 14 males and 124 females,mean age(36.07±8.49)years(20-55 years),thyroid tumor size(7.74±6.49)mm(2.4-50mm),5 cases underwent Subtotal thyroidectomy,129 cases underwent Unilateral lobectomy+lymph node dissection in the middle region,and 4 cases total thyroidectomy+central zone lymph node dissection.The number of surgical cases corresponding to the apex of the CUSUM learning curve was 45,and the learning curve was divided into two stages:the learning improvement stage(1-45 cases)and the mastery stage(46-138 cases).The operative time,intraoperative bleeding,postoperative hospital stay,and chin numbness were all lower in the proficiency period than in the learning and training period(P<0.05),and the number of lymph nodes cleared in the central region was larger than that in the learning and improvement stage(P<0.05),while the differences in other indexes between the two stages were not statistically significant(P>0.05).Conclusion The single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach has clinical application value and is worth promoting,and the number of surgical cases to be accumulated to master this technique is 45.