单操作孔电视胸腔镜肺叶切除术的学习曲线研究

目的 探讨单操作孔肺叶切除术的学习曲线.方法 回顾性研究解放军总医院胸外科自2009年1月至2013年5月采用单操作孔电视胸腔镜肺叶切除治疗的200例早期肺癌患者的病历资料.按手术时间顺序将患者分为5组（A、B、C、D、E组）,每组40例,比较各组手术时间、术中出血量、并发症、术后住院时间、淋巴结清扫数目及引流管拔出时间.结果 5组患者的术中出血量、并发症发生率、淋巴结清扫数目及引流管拔出时间比较,差异均无统计学意义（均P ＞0.05）.手术时间A组（210±11）min、B组（169 ± 11）min、C组（163±8）min、D组（174 ±8）min、E组（159±6）min,差异有统计学意义（P＜0.005）;术后住院时间A组（12.5 ±0.6）d、B组（9.5±0.4）d、C组（10.1±0.4）d、D组（10.4±0.4）d、E组（9.6±0.4）d,差异有统计学意义（P＜0.005）.5组患者术中出血量、淋巴结清扫数目、术后并发症及拔管时间差异无统计学意义（P＞0.05）.结论 单操作孔电视胸腔镜肺叶切除术的学习曲线大约是40例.

Learning curve of single utility port of complete video-assisted thoracoscopic lobectomy

Objective To evaluate the surgical outcomes and to explore the learning curve of single utility port of complete video-assisted thoracoscopic lobectomy.Methods We retrospectively analyzed the clinical data of 200 consecutive patients with early-stage lung cancer who underwent single utility port of complete video-assistedthoracic surgery（VATS） lobectomy from January 2009 to May 2013 in Chinese PLA General Hospital.The patients were divided into 5 groups from group A to E,according to the surgery date.The clinical outcomes included operation time,intraoperative blood loss,number resected lymph nodes,postoperative complications,hospitalization time and chest drainage duration.Results There were no statistical differences in the intraoperative blood loss,postoperative complications,number of lymph nodes cleaning and chest drainage duration.Operation time showed group A（210 ± 11） min,group B （169 ± 11） min,group C （163 ± 8） min,group D （174 ± 8） min and group E （159 ± 6） min.Hospitalization time showed group A （12.5 ± 0.6） d,group B （9.5 ± 0.4） d,group C （10.1 ± 0.4） d,group D（10.4 ±0.4） d and group E（9.6 ±0.4） d.There were statistical differences in the operation time and hospitalization time.The difference of intraoperative blood loss,number of lymph node cleaning,postoperative complications and extubation time among five groups had no statistical significances （P 〉 0.05）.Conclusion The learning curve of single utility port complete VATS lobectomy is approximately 40 cases.