目的探讨学习曲线期腹腔镜胰十二指肠切除术(LPD)治疗体会。方法回顾性分析郑州大学附属郑州中心医院肝胆胰外科2017年6月至2019年12月间实施的71例LPD患者的临床资料,包括全腹腔镜胰十二指肠切除术(TLPD)以及腹腔镜下标本切除、上腹部...目的探讨学习曲线期腹腔镜胰十二指肠切除术(LPD)治疗体会。方法回顾性分析郑州大学附属郑州中心医院肝胆胰外科2017年6月至2019年12月间实施的71例LPD患者的临床资料,包括全腹腔镜胰十二指肠切除术(TLPD)以及腹腔镜下标本切除、上腹部切口消化道重建的腹腔镜辅助胰十二指肠切除术(LAPD)两种术式。按照时间将前15个月完成的32例设为初期组,其后16个月完成的39例设为后期组。统计分析初期组和后期组中TLPD术和LAPD术情况,两组TLPD术的术前、术中、术后相关临床指标。结果患者均顺利完成手术。在初期组中,TLPD术与LAPD术分别为9例(28.1%)和23例(71.9%);与LAPD术比较,TLPD术手术时间[(425.0±34.0)min vs (330.9±14.7)min,t=11.067,P<0.001]、胰肠吻合时间[(46.6±2.2)min vs (21.2±7.4)min,t=9.993,P<0.001]均延长,术后B/C级胰瘘发生率增高[4例(44.4%) vs 1例(4.3%),P=0.015],差异均有统计学意义(P<0.05)。在后期组中,TLPD术与LAPD术分别为30例(76.9%)和9例(23.1%);与LAPD术比较,TLPD术手术时间[(376.0±23.7)min vs (345.6±19.1)min,t=3.498,P=0.001]、胰肠吻合时间[(34.1±6.5)min vs (16.5±1.3)min,t=7.758,P<0.001]均延长,差异均有统计学意义(P<0.05),但术后B/C级胰瘘发生率两种术式间无统计学差异(P>0.05)。与初期组TLPD术比较,后期组TLPD术手术时间[(376.0±23.7)min vs (425.0±34.0)min,t=-4.904,P<0.001]、胰肠吻合时间明显缩短[(34.1±6.5)min vs (46.6±2.2)min,t=-5.634,P<0.001],术后B/C级胰瘘发生率明显降低[3例(10.0%) vs 4例(44.4%),P=0.037]。结论在学习曲线期,TLPD术手术时间长,胰肠吻合时间长,胰瘘发生率高。可将LAPD作为消化道重建困难、胰瘘风险高的患者的辅助术式,手术医师再逐步提升TLPD术技术水平。展开更多
This paper presents an optimal production model for manufacturer in a supply chain with a fixed demand at a fixed interval with respect to the learning effect on production capacity. An algorithm is employed to find t...This paper presents an optimal production model for manufacturer in a supply chain with a fixed demand at a fixed interval with respect to the learning effect on production capacity. An algorithm is employed to find the optimal delay time for production and production time sequentially. It is found that the optimal delay time for production and the production time are not static, but dynamic and variant with time. It is important for a manufacturer to schedule the production so as to prevent facilities and workers from idling.展开更多
文摘目的探讨学习曲线期腹腔镜胰十二指肠切除术(LPD)治疗体会。方法回顾性分析郑州大学附属郑州中心医院肝胆胰外科2017年6月至2019年12月间实施的71例LPD患者的临床资料,包括全腹腔镜胰十二指肠切除术(TLPD)以及腹腔镜下标本切除、上腹部切口消化道重建的腹腔镜辅助胰十二指肠切除术(LAPD)两种术式。按照时间将前15个月完成的32例设为初期组,其后16个月完成的39例设为后期组。统计分析初期组和后期组中TLPD术和LAPD术情况,两组TLPD术的术前、术中、术后相关临床指标。结果患者均顺利完成手术。在初期组中,TLPD术与LAPD术分别为9例(28.1%)和23例(71.9%);与LAPD术比较,TLPD术手术时间[(425.0±34.0)min vs (330.9±14.7)min,t=11.067,P<0.001]、胰肠吻合时间[(46.6±2.2)min vs (21.2±7.4)min,t=9.993,P<0.001]均延长,术后B/C级胰瘘发生率增高[4例(44.4%) vs 1例(4.3%),P=0.015],差异均有统计学意义(P<0.05)。在后期组中,TLPD术与LAPD术分别为30例(76.9%)和9例(23.1%);与LAPD术比较,TLPD术手术时间[(376.0±23.7)min vs (345.6±19.1)min,t=3.498,P=0.001]、胰肠吻合时间[(34.1±6.5)min vs (16.5±1.3)min,t=7.758,P<0.001]均延长,差异均有统计学意义(P<0.05),但术后B/C级胰瘘发生率两种术式间无统计学差异(P>0.05)。与初期组TLPD术比较,后期组TLPD术手术时间[(376.0±23.7)min vs (425.0±34.0)min,t=-4.904,P<0.001]、胰肠吻合时间明显缩短[(34.1±6.5)min vs (46.6±2.2)min,t=-5.634,P<0.001],术后B/C级胰瘘发生率明显降低[3例(10.0%) vs 4例(44.4%),P=0.037]。结论在学习曲线期,TLPD术手术时间长,胰肠吻合时间长,胰瘘发生率高。可将LAPD作为消化道重建困难、胰瘘风险高的患者的辅助术式,手术医师再逐步提升TLPD术技术水平。
基金Funded by National Social Sciences Fund for Young Scholar ( No.020JY027)
文摘This paper presents an optimal production model for manufacturer in a supply chain with a fixed demand at a fixed interval with respect to the learning effect on production capacity. An algorithm is employed to find the optimal delay time for production and production time sequentially. It is found that the optimal delay time for production and the production time are not static, but dynamic and variant with time. It is important for a manufacturer to schedule the production so as to prevent facilities and workers from idling.
