腹腔镜下宫颈癌根治术的学习曲线的分析

目的：通过分析比较腹腔镜宫颈癌根治术的围手术期相关结果来绘制其学习曲线，大致评估腹腔镜宫颈癌根治术的困难程度，为妇科恶性肿瘤特别是宫颈癌的腹腔镜手术的学习提供参考依据。方法回顾性分析该院40例腹腔镜下广泛全子宫加盆腔淋巴结清扫患者的临床资料。按手术日期的先后顺序分为4个手术阶段。比较各阶段平均手术时间、术中平均出血量、中转开腹率、围手术期输血率、淋巴清扫数目、术后病率、术后感染率、手术并发症、术后平均住院时间，进行统计学分析，了解不同时间段的手术效果，并以简单正弦拟合学习曲线。结果各阶段手术时间、术中出血量均呈下降趋势，进一步两两比较，手术时间仅Ⅲ、Ⅳ阶段手术时间无统计学差异（P ＝0．5275）；术中出血量仅Ⅰ阶段术中出血量（470±59．98）mL 明显多于Ⅳ阶段（317．0±25．52）mL（P ＝0．0306）。围手术期输血率呈持续下降趋势；各阶段术后平均住院时间、淋巴清扫数目、术后病率、术后感染率比较差异无统计学意义（P ＞0．05）；总共仅1例手术并发症发生（输尿管阴道瘘，I 阶段），无1例中转开腹。以简单的振荡正弦曲线 Y＝sinx －π／2拟合移动平均线，手术时间的拐点为19例，术中出血量的拐点为23例。结论腹腔镜广泛全子宫加盆腔淋巴结清扫的学习曲线大约为20例，即可达到较熟练的水平且趋于稳定。

Learning curve analysis of peritoneoscopic radical hysterectomy of cervical cancer

Objective To assess the difficulty of peritoneoscopic radical hysterectomy of cervical cancer by constructing leaming curves,so as to provide reference for the study of gynecologic malignancies especially peritoneoscopic surgery for cervical cancer.Meth-ods A retrospective analysis was made of the clinical data of 40 cases of peritoneoscopic hysterectomy and extensive pelvic lymphade-nectomy in The Affiliated Provincial Hospital of Anhui Medical University.The surgery was assigned into four stages according to the surgery date order,and we compared the results in different stages,which included average time,intraoperative blood loss,transit opera-tion rate,perioperative blood transfusion rate,number of lymph node cleaning,disease rate after operation,postoperative infection,surgi-cal complications and the average length of hospital stay.These results were statistically analyzed to get to know the surgical effect at different stages and the learning curve was obtained.Results The operation time,intraoperative blood loss are declining at each stage. By further comparison,there was no statistical difference in the operation time only between stage III and IV (P =0.527 5).The bleed-ing amount of intraoperative blood loss at stage I was significantly more than that at stage IV (470 ±59.98)mL vs (317.0 ±25.52) mL](P =0.030 6).Perioperative blood transfusion rate showed a falling trend.There were no statistical significance in the average postoperative hospital stay,number of lymph node cleaning,disease rate after operation and postoperative infection between stages (P >0.05).There was only 1 case of surgical complication (vaginal ureter fistula,phase I).No case transferred to laparotomy.With simple oscillation sine curve Y=sinx-π/2 fitting moving averages,the inflexion point of operation time could be found in 19 cases,and that of intraoperative blood loss was found in 23 cases.Conclusions The learning curve of peritoneoscopic radical hysterectomy of cervical cancer is approximately 20 cases,which can achieve a level of proficiency and consistency.