经剑突下入路胸腔镜下前纵隔肿瘤切除术学习曲线分析

目的 探讨经剑突下入路胸腔镜下前纵膈肿瘤切除术的学习曲线和临床应用.方法 收集经剑突下入路胸腔镜下前纵膈肿瘤切除术患者33例,按照手术日期的先后顺序分3组(A,B,C组),每组11例.比较各组患者的手术时间、术中出血量、中转开胸率、术后并发症、术后住院天数、纵膈引流量等,分析不同阶段的手术效果.结果 3组患者在性别、年龄、术前合并症、肿瘤大小、体质量指数、纵膈引流量、中转开胸率、术后住院天数、术后并发症、拔管时间等方面差别均无统计学意义(P>0.05).A组的手术时间为(151.91±39.53)min(107~227 min),显著长于B组(97.91±19.36)min(70~150 min)和C组(77.27±10.88)min(55~100 min)(P<0.05).A组的术中出血量为(39.09±26.25)m L(10~100 m L),显著多于B组(20.73±12.28)m L(3~40 m L)和C组(18.18±13.83)m L(5~50 m L)(P<0.05).结论 微创腔镜技术经验丰富的手术医师经剑突下入路胸腔镜下前纵隔肿瘤切除术的学习曲线大约是11例.

Learning Curve of Subxiphoid Approach in Video assisted Thoracoscopic for the Treatment of Anterior Mediastinal Tumor

Objective To investigate the learning curve of subxiphoid approach in video-assisted thoracoscopic resection of anterior mediastinal tumor . Methods Retrospective analyses were conducted on the clinical data of 33 patients with anterior mediastinal tumor or myasthenia gravis ,which underwent subxiphoid approach in video-assisted thoracoscopic . The subjects were chronologically divided into three groups (group A ,group B ,and group C) ,with 11 cases in each group . The surgical duration ,intraop-erative blood loss ,the rate of conversion to thoracotomy ,complications ,duration of hospital stay ,and mediastinal drainage tube indwelling time were individually compared among the three groups . We then analyzed operational effects of different stages . Results T he clinical date including gender ,age ,compli-cations ,size ,BMI(body mass index) ,mediastinal drainage ,rate of conversion to thoracotomy ,postopera-tive hospital stays ,complications as well as mediastinum drainage tube indwelling time were all statistical-ly not different among the three groups(P>0 .05) . The operation time of group A was between 107 and 227 minutes (151 .91 ± 39 .53 min) ,significantly longer than those of group B ,which were between 70 and 150 minutes (97 .91 ± 19 .36 min) and group C ,which were between 55 and 100 minutes (77 .27 ± 10 .88 min) , P<0 .05 . The intraoperative blood loss was significantly more in group A (10~100 mL ,39 .09 ± 26 .25 mL) than in group B (3~40 mL ,20 .73 ± 12 .28 mL) and group C (5~50 mL ,18 .18 ± 13 .83 mL) ,P<0 .05 . Conclusion For surgeons with extensive experience in minimally invasive endoscopic techniques ,the learning curve of subxiphoid approach in video-assisted thoracoscopic for the treatment of anterior medias-tinal tumor is approximately 11 cases .