单切口腹腔镜辅助腹膜外鞘状突未闭结扎术的学习曲线

目的评估不同年资的医师在不同时期行单切口腹腔镜辅助腹膜外鞘状突未闭结扎术的手术效果,探讨该技术的学习曲线。方法回顾性分析2013年1月至2015年1月间我科同一手术团队6名医师完成的120例该术式的手术资料。根据主刀医师已从事腹腔镜手术的年资分为A组(年份3年,3位医师)、B组(年份3年,3位医师)。每位医师取完成的前20例患者,各组按手术时间顺序分为4阶段(每组15例/每阶段),分别比较各组病例的手术时间、术中出血量、中转开放手术率、术后住院时间、短期及长期并发症情况,制定学习曲线。结果各组间年龄差异无统计学意义,术中出血均小于10 mL,无中转开放手术病例,均于术后次日出院,4例出现短期并发症,均无长期并发症发生。A组医师手术时间第2~4阶段明显短于第一阶段;B组医师手术时间第3~4阶段明显短于第1~2阶段。结论具有一定腔镜手术基础的医师,单切口腹腔镜辅助腹膜外鞘状突未闭结扎术的学习曲线约为5例;腔镜手术基础欠丰富的医师,该手术的学习曲线约为10例。单切口腹腔镜辅助腹膜外鞘状突未闭结扎术治疗小儿腹股沟斜疝或鞘膜积液安全有效、美观微创、操作简单、易于掌握,值得推广普及。

Learning curve of single-incision laparoscopic repair for inguinal hernia and hydrocele in children

Objetive To evaluate the learning curve of single-incision laparoscopic repair for inguinal hernia and hydrocele in children by comparing the outcomes of this technique for surgeons of different seniori-ties. Methods Reviews were conducted for 120 consecutive selected patients with inguinal hernia or hydro-cele undergoing single-incision laparoscopy from January 2013 to January 2015 by surgeons of different seniori-ties.They were divided into group A of 60 patients operated by 3 senior surgeons and group B of 60 patients op-erated by 3 junior surgeons.Each group was divided into 4 stages by operative date.Operative duration,blood loss,conversion rate into open technique,postoperative hospital stay and short &long-term complications were analyzed statistically. Results Both groups were similar in age.All cases underwent single-incision laparos-copy without conversion and were discharged the same day.Except for 4 short-term minor complications,there was no serious blood loss or major complications.The operative durations of stage II /III /IV were significantly shorter than those of stage I in group A while operative durations of stage III /IV were significantly shorter than those of stage I /II in group B. Conclusions The learning curve of single-incision laparoscopic repair for in-guinal hernia and hydrocele is approximately 5 cases for senior surgeons and 10 cases for junior surgeons.