全胸腔镜下左心房黏液瘤摘除术的技术准备及学习曲线

Learning Curve and Technical Preparation of Totally Thoracoscopic in Left Atrium Myxoma Surgical

目的通过评估全胸腔镜行左心房黏液瘤摘除术开展初期阶段的相关参数,探讨全胸腔镜行左心房黏液瘤摘除术所需的技术准备及学习曲线。方法回顾性分析2018年9月至2022年4月北部战区总医院心血管外科同一术者连续完成的103例全胸腔镜下左心房黏液瘤摘除术的临床资料。记录全胸腔镜左心房黏液瘤摘除术连续病例的手术时间、体外循环时间、主动脉阻断时间,采用lowess局部加权回归散点平滑法拟合曲线,分析变化趋势,寻找掌握并成熟开展该类技术的病例累积要求,探讨其学习曲线。结果全胸腔镜左心房黏液瘤摘除术在累积病例到接近39例时,手术时间稳定在210 min左右;累积病例到接近31例时体外循环时间稳定在90 min左右,累积病例到接近33例时主动脉阻断时间稳定在40 min左右。结论全胸腔镜左心房黏液瘤摘除术的学习曲线大约为30例,术者的心外科手术技术、腔镜技术熟悉程度及团队配合是手术成熟的必要的支持。

Objectives To evaluate the learning curve and technical preparation of totally thoracoscopic in surgical treatment of left atrium myxoma on the initial period stage.Methods Clinical data of 103 patients who undergoing totally thoracoscopic cardiac surgery for left atrium myxoma excision from September 2018 to April 2022 in General Hospital of Northern Theater Command was analyzed retrospectively.The operation duration,extracorporeal circulation duration and aortic cross-clamping duration of continuous patients who undergoing totally thoracoscopic cardiac surgery for left atrium myxoma excision were recorded.Lowess smoothing method was performed to fit curve to evaluate the variation tendency of surgical parameters.Results Through operation duration,surgical duration tended to be stable(almost 210 min)when the cumulative case amount of totally thoracoscopic in surgical treatment of left atrium myxoma reached 39 cases.Through extracorporeal circulation duration,surgical duration tended to be stable(almost 90 min)when the cumulative case reached 31.Through aortic cross-clamping duration,surgical duration tended to be stable(almost 40 min)when the cumulative case reached 33.Conclusions The learning curve of total thoracoscopic cardiac surgery for left atrium myxoma excision is about 30 cases.The operators′cardiac surgery techniques,endoscopic skill and team cooperation are the necessary support for the maturity of the operation.