腹腔镜膀胱全切手术:单中心60例学习曲线结果分析

目的:腹腔镜膀胱全切手术因为创伤小、术后恢复快等优点在临床得到了越来越多的应用,本研究回顾性分析了北京大学第一医院单个外科医生60例腹腔镜膀胱全切手术的学习曲线,探讨如何缩短腹腔镜膀胱全切手术时间、减少出血、减少并发症,分析医生从第1例手术到熟练掌握手术技术的过程。方法:回顾性分析2004年5月至2012年1月北京大学第一医院单个外科医生完成的60例腹腔镜膀胱全切手术,其中女性9例,男性51例,平均年龄(60.8±11.4)岁,平均体重指数(body mass index,BMI)(23.9±2.7)kg/m2。按手术先后顺序分为A、B、C组,每组20例,比较3组的手术时间、术中出血、术后住院日等方面的差异。结果:平均术中出血为(799.2±717.8)mL,平均手术时间为(420.2±119.8)min;平均术后住院日为(15.7±11.0)d。3组患者在年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、BMI等方面差异均无统计学意义(P>0.05);手术时间A组(497.5±131.2)min、B组(413.6±75.6)min、C组(349.4±100.2)min,差异有统计学意义(P<0.001);术中出血A组(1 080.0±1 028.8)mL、B组(862.5±510.6)mL、C组(455.5±262.3)mL,差异有统计学意义(P=0.018);术后住院日A组(20.8±13.5)d、B组(16.4±10.6)d、C组(9.8±4.4)d,差异有统计学意义(P=0.005);而在术后并发症方面,3组之间差异无统计学意义。结论:腹腔镜膀胱全切手术例数的累积可以显著缩短手术时间,减少术中出血,缩短术后住院日。经过大约20例手术后,医生可以达到较熟练掌握手术技术的程度;经过大约40例手术后,医生的手术熟练和稳定程度明显提高。

Laparoscopic radical cystectomy: analysis of a single-surgeon learning curve of 60 cases

Objective:To evaluate the changes in perioperative outcomes that might refect progress along the learning curving by a single-surgeon’s experience in our institution with laparoscopic radical cystectomy(LRC).Methods: This report was conducted between May 2004 and January 2012 in 60 patients(9 women and 51 men) who underwent LRC for bladder cancer.The mean patient age was(60.8±11.4) years,and mean BMI was(23.9±2.7) kg/m2.We divided the patients into 3 groups(group A,group B,and group C;each group had twenty patients) by the time,and compared the ope-rative time,intraoperative blood loss,hospital stay among the three groups.Results: The mean intraope-rative blood loss was(799.2±717.8) mL,the mean operative time was(420.2±119.8) minutes,and the mean hospital stay was(15.7±11.0) d;There was no statistically significant difference in age,American Society of Ansthesiologists(ASA) scores and BMI among the three groups(P>0.05).Their operative time was(497.5±131.2),(413.6±75.6) and(349.4±100.2) minutes,respectively,for each group,P<0.001.The intraoperative blood loss was(1 080.0±1 028.8),(862.5±510.6) and(455.5±262.3) mL,for each group,P=0.018.The hospital stay was(20.8±13.5),(16.4±10.6) and(9.8±4.4) d,for each group,P=0.005.However,there was no statistically significant difference in postoperative complications among the three groups.Conclusion: Our experience of LRC appears to be favorable with reduction in blood loss,operative time and hospital stay with increasing experience.The curving shows a significant decline at 2 different breakpoints: after the first 20 cases,and after 40 cases.