腹腔镜下脾切除手术的学习曲线分析

目的: 评价腹腔镜下脾切除不同阶段的手术效果,探讨其学习曲线问题。方法: 回顾性分析中南大学湘雅二医院普通外科近2年内由同一手术团队完成的40例腹腔镜下脾切除手术。按施行手术的时间次序分为4组(I,II,III,IV),每组10例。比较各组手术时间、术中出血量、中转开腹率、中转手助腹腔镜脾切除率、术后住院时间、术后恢复流质时间、术中术后并发症情况以及手术频数,分析不同阶段的手术效果。结果: 4组患者在年龄、性别方面差别无统计学意义(P>0.05)。III,IV组手术时间、术中出血量和术后住院时间明显少于I,II组(P<0.05)。各组术后恢复流质时间依次缩短但差异无明显统计学意义(P>0.05)。4组在中转率和术后并发症方面差异无统计学意义(P>0.05)。I~IV组手术频数从1.25台/月增加到2.5台/月。结论: 有丰富开腹脾切除经验和一定腹腔镜基础的普外科医师,腹腔镜下脾切除手术的学习曲线约为20例,手术频数为1.33台/月。

Analysis of learning curve of laparoscopic splenectomy

Objective:To evaluate the surgical outcomes of laparoscopic splenectomy and to investigate the learning curve of laparoscopic splenectomy.Methods:Forty cases of laparoscopic splenectomy(performed by W.Y.between September 2008 and August 2010) in our general surgery department were reviewed,and the cases were divided equally into 4 groups(group I,II,III,IV) according the time sequence of the operations.The operating time,blood loss,conversion to open surgery,conversion to hand-assisted laparoscopic splenectomy,postoperative hospital stay,postoperative liquid diet recovery time,intra-and post-operative complications and the operative frequency were compared.Results:There were no statistical differences among the groups in age and gender(P>0.05).The operating time,blood loss and postoperative hospital stay of groups III and IV were significantly less than those of groups I and II(P<0.05).Postoperative liquid diet recovery time appear to show a gradual shortening trend from Group I to Group IV,but the differences were not at standard statistical thresholds(P>0.05).Frequency of conversion to open surgery,of conversion to hand-assisted laparoscopic splenectomy,of complications among the four groups were also not statistically different(P>0.05).The operative frequency of group I–IV increased from 1.25/month to 2.5/month.Conclusion:The learning curve of laparoscopic splenectomy for surgeon who was experienced in open splenectomy and laparoscope cholecystectomy is approximately 20 cases,and the operative frequency is about 1.33/month.