腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术学习曲线

Learning Curve of Laparoscope Radical Adenomyosis Resection by Temporary Uterine Artery Blocking

目的:探讨腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术学习曲线。方法:回顾分析常州市妇幼保健院2015年12月—2023年8月收治的151例进行腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术患者的临床资料。采用累计求和分析(cumulative sum analysis,CUSUM)法绘制学习曲线,根据所得曲线的临界点将整个过程分为提高期(47例)和熟练期(104例),分析比较2组患者的临床资料和手术结果。结果:根据患者手术时间和手术例数形成手术时间序列图,拟合曲线为y=-27.17ln(x)+330.74(x=手术例数)。根据手术时间绘制的CUSUM曲线的最佳拟合曲线方程为y=-0.005x^(3)-1.387x^(2)+98.643x-253.571(x为手术例数,最优拟合系数R2=0.931,P<0.05),48例即为该手术达到熟练期所需累积的例数。提高期患者手术时间[(263.72±38.07)min vs.(201.65±48.03)min,P<0.001]、术后持续发热率(40.43%vs.22.12%,P=0.020)和术后体温[38.0(37.8,38.1)℃vs.37.7(37.5,38.0)℃,P=0.002]均高于熟练期患者。两阶段患者的术后血红蛋白水平和手术前后血红蛋白差值比较,差异均无统计学意义(P>0.05)。结论:子宫动脉临时阻断能够有效控制术中出血量,术者约需完成48例腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术达到技术熟练,但仍需不断熟练手术操作,降低患者感染风险。

Objective:To investigate the learning curve of radical adenomyosis resection by temporary uterine artery blocking via laparoscopy.Methods:Retrospectively analysis on the clinical data of 151 patients who underwent laparoscopic radical adenomyosis resection by temporarily uterine artery blocking from December 2015 to August 2023 in Changzhou Maternal and Child Health Hospital was conducted.The learning curve was drawn by cumulative sum analysis(CUSUM),and the whole process was divided into improvement stage(47 cases)and proficiency stage(104 cases)based on the cut-off point of the curve.Clinical data and surgical results were analyzed.Results:The fitting curve equation for the surgical time series was y=-27.17ln(x)+330.74(x=cases number)based on the patients′operation time and surgery cases number.The optimal fitting curve equation for CUSUM curve was y=-0.005x^(3)-1.387x^(2)+98.643x-253.571(x=cases number,the optimal fitting coefficient R2=0.931,P<0.05),when the cumulative number of cases reached to 48,requirement for proficiency stage will be achieved.The operation time[(263.72±38.07)min vs.(201.65±48.03)min,P<0.001],persistent postoperative fever rate(40.43%vs.22.12%,P=0.020)and body temperature[38.0(37.8,38.1)℃vs.37.7(37.5,38.0)℃,P=0.002]were higher for patients in improvement stage than those in proficiency stage.There was no significant difference of postoperative hemoglobin level and the difference of hemoglobin before and after operation between the two stages(P>0.05).Conclusions:Intraoperative blood loss was controlled effectively by temporary uterine artery blocking.The surgeon needs to complete approximately 48 laparoscopic surgery cases for radical adenomyosis resection via temporary uterine artery blocking before technical proficiency was achieved and sustained surgical skill was required for reduction of infection risk.