手术模式的流程化设计对腹腔镜根治性肾切除术学习曲线的影响

目的：探讨腹腔镜根治性肾切除术（laparoscopic radical nephrectomy，LRN）手术模式的流程化设计对其学习曲线的影响。方法：将LRN手术模式进行流程化设计，并以此模式对青年腹腔镜医师进行LRN培训，然后于2009年1月～2011年1月间按此模式行LRN30例，分析其学习曲线，并与以往LRN学习曲线相比较。结果：试验组学习曲线的“转折点”较对照组明显提前。试验组的平均手术时间和平均术中出血量较对照组明显降低，差异有统计学意义，而中转开放例数和术后并发症较对照组亦有所减少，但差异无统计学意义。结论：通过对LRN进行流程化设计，进而制定LRN培训体系并对青年医师进行LRN培训，可以缩短LRN的学习曲线。

A Streamlining Design of Laparoscopic Radical Neph-Rectomy and Its Effect on Learning Cure

Objective:To study a streamlining design of laparoscopic radical nephrectomy(LRN) and its effect on learning cure.Methods:Young laparoscopic doctor had a training of LRN.which was streamlined in mode and procedure.Then initial 30 cases by streamlining LRN between Jan.2009 and Jan.2011 were collected and the learning curve of LRN was analyzed.And 30 cases which underwent conventional LRN previously were recruited and served as controls.Results:The turning point of learning curve was appeared ahead of time in experimental group than in control group.The average operation time and blood loss were lower in experimental group than in control group with a significant difference.The transfusion rate and postoperative complications were also decreased in experimental group than in control group,but show no significant difference.Conclusions:The learning curve of LRN can be shortened by LRN training with a streamlining design.