结肠癌完整结肠系膜切除术的学习曲线

目的探讨结肠癌完整结肠系膜切除术（CME）的学习曲线。方法回顾性分析2009年11月至2011年6月间,在北京大学人民医院胃肠外科接受CME手术的75例结肠癌患者的临床资料,按手术先后依次分A、B、C3组,每组25例。结果3组病例一般资料的比较差异均无统计学意义（均P〉0．05）。A、B、C3组患者手术时间依次递减,A组显著长于B组和C组[（205．4±53．2）rain比（180．4±29．7）min和（169．8±4113）rain,P〈0．05];3组住院时间也依次递减,A组也显著长于B组和C组[（17．8±10．9）d比（12．9±4．1）d和（11．0±3．5）d,P〈0．05]。C组患者术后并发症发生率（8％,2／25）明显低于A组（32％．8／25）和B组（36％,9／25）（P〈0．05）。C组患者手术标本的质量明显优于A组（大体标本WESTC级以上例数分别为20例和11例,P〈0．05）。3组术中出血量、肛门排气时间、术后进食时间、淋巴结检获数方面的差异均无统计学意义（均P〉0．05）。结论结肠癌CME手术的学习曲线大约为25例,即可达到较熟练程度。

Learning curve of complete mesocolic excision for colon cancer

Objective To evaluate the learning curve of complete mesocolic excision （CME） for colon cancer. Methods Clinical data of 75 cases in whom CME was performed by a group of surgeons in the Department of Gastrointestinal Surgery, Peking University People＇s Hospital from November 2009 to June 2011 were reviewed. The patients were divided into three groups （groups A, B, C, 25 cases in each group） by operative chronologic sequence. Results There were no significant differences in age, sex, preoperative staging, cancer location, operation history of abdomen, ASA among the three groups （P〉0.05）. The operative time in group A was （205.4±53.2） rain and decreased to （180.4±29.7） min in group B and （169.8±41.3） rain in group C （P〈0.05）. The postoperative hospital stay decreased from （17.8±10.9） d in group A to （12.9±4.1） d in group B and （11.0_＋3.5） d in group C （P〈0.05）. The postoperative eomplication rate decreased from 32% （8/25） in group A and 36% （9/25） to 8% （2/25） in group C. The specimen quality was superior in group C compared to group A （WEST grade C above were 20 and 11 respectively, P〈0.05 ）. There were no significant differences in intraoperative bleeding, time to first flatus, postoperative fasting time, number of retrieved lymph nodes among the three groups （P〉0.05）. Conclusion From the learning curve of CME, surgeons can learn CME skill after performing 25 cases.