腹腔镜前列腺根治性切除术的学习曲线

目的探讨腹腔镜前列腺根治性切除术的学习曲线。方法回顾分析2004年1月～2011年5月我院由同一医师完成的180例腹腔镜前列腺根治性切除术的临床资料。按手术先后顺序分为4组（A、B、C、D组）,每组45例,比较各组手术时间、出血量、切缘阳性率、输血率、术后住院时间、并发症发生率。结果中转开放率为1.1%（2/180）,均发生在A组。A组手术时间为（284.5±67.7）min,显著长于B组（213.7±42.6）min（q=9.491,P〈0.05）,C组（229.7±40.9）min（q=7.346,P〈0.05）和D组（235.4±42.6）min（q=6.582,P〈0.05）。输血率由A组的18.6%（8/43）,下降至B组4.4%（2/45）,C组6.7%（3/45）和D组2.2%（1/45）（χ2=9.637,P=0.022）。A组术后住院时间中位数12 d（5～60 d）,显著长于B组9 d（5～36 d）,C组10 d（6～60 d）和D组10 d（4～38 d）（Z值分别为-2.600,-1.993,-2.112,P值分别为0.009,0.046,0.035）。A组出血量为中位数300 ml（100～3000 ml）,显著多于B组200 ml（50～1200 ml）（Z=-3.050,P=0.002）和D组150 ml（30～700 ml）（Z=-4.060,P=0.001）。4组切缘阳性率及并发症发生率并无显著差异（χ2=0.907,P=0.824;χ2=0.270,P=0.966）。结论腹腔镜前列腺根治性切除术的学习曲线大致为45例。

Learning Curve for Laparoscopic Radical Prostatectomy

Objective To discuss the learning curve of laparoscopic radical prostatectomy. Methods We retrospectively analyzed the clinical data of 180 patients,who underwent laparoscopic radical prostatectomy from January 2004 to May 2011 in our hospital by a same surgeon.The patients were divided into four groups(groups A,B,C,and D,45 cases in each) by time sequence.The operation time,blood loss,the rates of blood transfusion,positive surgical margin,and postoperative complications,as well as postoperative hospital stay were compared among the four groups.Results The rate of conversion to open surgery was 1.1%(2/180) in all the patients,and all of these cases were from group A.Group A showed significantly longer operation time,higher rate of blood transfusion,and longer median hospital stay than those in the groups B,C,and D (284.5±67.7) min vs.(213.7±42.6) min(q=9.491,P<0.05),(229.7±40.9) min(q=7.346,P<0.05),and(235.4±42.6) min(q=6.582,P<0.05);18.6%(8/43) vs.4.4%(2/45),6.7%(3/45),and 2.2%(1/45),χ2=9.637,P=0.022);12 d(5-60 d),vs.9 d(5-36 d),10 d(6-60 d),and 10 d(4-38 d);Z=-2.600,-1.993,and-2.112,and P=0.009,0.046,and 0.035,respectively].Furthermore,group A had significantly more median blood loss than groups B and D 300 ml(100-3000 ml) vs.200 ml(50-1200 ml)(Z=-3.050,P=0.002),and 150 ml(30-700 ml)(Z=-4.060,P=0.001)].No significant difference was found in the rates of positive surgical margin and postoperative complications(χ2=0.907,P=0.824;χ2=0.270,P=0.966).Conclusion The learning curve of laparoscopic radical prostatectomy consists approximately 45 cases in our hospital.