达芬奇机器人直肠癌根治术的学习曲线

目的探讨达芬奇机器人直肠癌根治术的学习曲线。方法回顾分析我院微创胃肠外科中心2010年3月～2012年5月完成的60例达芬奇机器人直肠癌根治术的临床资料，按手术先后顺序分成A、B、C3组，每组20例，比较各组机器人安装时间、手术时间、出血量、淋巴结清扫数目、并发症、术后住院时间。结果A组机器人安装时间（66±6）min，显著长于B组（35±5）min和c组（32±4）min（q=27．365，P〈0．05；q=30．013，P〈0．05），B、C2组无统计学差异（q=2.648，P〉0．05）。3组手术时间无统计学差异（F=1．28，P=0．286），总手术时间差异（F=8．82，P=0．000）主要由于机器人安装时间差异，机器人直肠癌根治术学习曲线为20例。3组出血量、淋巴结清扫数目、并发症、术后住院时间无显著性差异（P〉0．05）。结论对于熟练掌握腹腔镜直肠癌根治术的外科医生，达芬奇机器人直肠癌根治术学习曲线约为20例。

Learning Curve of Da Vinci Robot-assisted Laparoscopic Radical Resection for Rectal Carcinoma

Objective To investigate the learning curve of Da Vinci robot-assisted laparoscopic radical resection for rectal carcinoma. Methods The clinical data of 60 cases of Da Vinci robot-assisted laparoscopie radical resection for rectal cancer performed between March 2010 and May 2012 were reviewed. The patients were sequentially divided into group A, B and C with 20 cases in each group. The robotic set-up time, operation time, blood loss, number of resected lymph nodes, surgical complications, and postoperative hospital stay were compared among the 3 groups. Results The robotic set-up time in group A was significantly longer than that in group B and C （66 ±6）rain vs. （35 ±5） min,q =27. 365,P 〈0.05 ; （66 ±6） min vs （32 ±4） min,q =30.013 ,P 〈0. 05], and there was no significant difference between group B and group C （q = 2. 648, P 〉 0.05 ）. There was no statistical difference in operation time among the three groups （ F = 1.28, P = 0.286 ）. There were significant differences in total operation time among the three groups （ F = 8.82,P = 0.0（30） , mainly due to the differences of robotic set-up time. The learning curve of Da Vinci robot-assisted laparoseopic radical resection for rectal cancer was 20 cases. No significant difference was found in blood loss, number of resected lymph nodes, surgical complications, and postoperative hospital stay among the 3 groups （ P 〉 0.05 ）. Conclusion For a well-trained surgeon in laparoscopie rectal cancer surgery, the learning curve of Da Vinci robot-assisted laparoscopie radical resection for rectal cancer is about 20 cases.