妇科腹腔镜全子宫切除术的学习曲线分析

目的   探讨妇科腹腔镜全子宫切除术（TLH）学习曲线。方法   将85例行TLH的患者按手术时间顺序分为4个阶段，其中第1、2、3阶段各20例，第4阶段25例。比较分析各个阶段的术中出血量、手术时间，并以简单正弦拟合学习曲线。结果   第4阶段术中出血量低于第1阶段(P<0.05)；第3、4阶段手术时间低于第1、2阶段，差异均有统计学意义(P<0.05)，而第3阶段与第4阶段手术时间差异无统计学意义(P>0.05)。以简单的振荡正弦曲线Y=sinx-π/2拟合移动平均线，拐点为41例。结论   TLH的学习曲线大约为40例，即可达到较熟练水平和稳定程度。

Study on the learning curve for total laparoscopic hysterectomy

Objective   To explore the learning curve of total laparoscopic hysterectomy(TLH). Methods   85 patients who received TLH were randomly divided into four phases according to their operation time, including 20 cases of Phase 1~3, 25 cases of Phase 4. The operation time and blood loss were compared and analyzed, and the learning curve was fitted with the simple sine curve. Results   The blood loss in Phase 4 was significantly lower than that in Phase 1(P<0.05). The operation time in Phase 3 and Phase 4 was significantly less than that in Phase 1 and Phase 2(P<0.05),while the difference was not significant between Phase 3 and Phase 4(P>0.05). Moving average line was fitted with the simple sine curve Y=sin-π/2, and the inflection point was 41. Conclusion   The learning curve for TLH1 is approximately 40 cases. And the surgeon can achieve a proficient level and stable degree.