摘要
目的:探讨机器人全腔内原位Studer新膀胱术(RISON)的学习曲线。方法:以累积和分析法(CUSUM)分析解放军总医院第三医学中心泌尿外科医学部自2018年3月至2022年6月由同一名主刀完成的RISON手术时间,用CUSUM对学习曲线进行拟合,并以R^(2)判断其拟合优度,从而比较学习曲线不同阶段的手术时间、术中出血量、淋巴结清扫个数、术后早期并发症、术后住院时间及随访情况等的差异,总结RISON手术从学习阶段进入熟练掌握阶段需要累积的手术例数。结果:该研究共纳入62例患者,其中男性60例(96.8%),女性2例(3.2%),年龄26~69岁,中位数58岁,BMI中位数24.8 kg/m^(2),9例(13.2%)患者术前使用新辅助治疗。62例RISON手术,手术时间3.5~10(6.32±1.48)h,无中转开腹手术病例。CUSUM(n)=OT(n)-OT(mean)+CUSUM(n-1),三次方曲线拟合优度最高(P<0.001,拟合优度系数R^(2)=0.864),拟合方程:CUSUM(n)=0.001n^(3)-0.099n^(2)+2.466n-3.669(n为手术例数)。拟合曲线在n=17时达到最高点。17例之前,CUSUM曲线持续上升,17例之后,曲线呈平稳下降。以此为分界,将学习曲线分为两个阶段,第1至第17例为学习阶段,第17例以后为熟练阶段。对比学习阶段和熟练阶段,两组基线数据均无统计学差异,手术时间(P=0.003)、术中出血量(P=0.002)、术后开始进食时间(P=0.005)、引流管数(P<0.001)差异具有统计学意义。结论:通过CUSUM法对全腔内机器人辅助原位新膀胱术的学习曲线进行分析,表明掌握该手术技术需累积的手术例数为17例。
Objective:To investigate the learning curve of robotic intracorporeal Studer's orthotopic neobladder(RISON).Methods:The operation time for RISON performed at the Senior Department of Urologyof the Third Medical Center of PLA General Hospital from March 2018 to June 2022 was analyzed using cumulative sum analysis(CUSUM).The CUSUM learning curve was fitted,and its goodness of fit was assessed using R^(2).Operation time,intraoperative bleeding,number of lymph node dissections,early postoperative complications,postoperative hospital andfollow-up situation were compared across different stages of the learning curve.Additionally,the number of operations required from the initial learning stageto reach proficiency stage was summarized.Results:A total of 62 patients were included in this study,including 60 males(96.8%)and 2 females(3.2%),with ages ranging from 26 to 69 years and a median age of 58 years.The median BMI was recorded as 24.8 kg/m^(2).9 patients(13.2%)received neoadjuvant therapy prior to surgeries.The operation time for all RISON procedures ranged from 3.5 to 10 hours,with an average of(6.32±1.48)hours.No conversions were observed within the entire group.CUSUM(n)=OT(n)-OT(mean)+CUSUM(n-1)demonstrated the highest goodness off it when modeled by cubic curves(P<0.001,R^(2)=0.864),with fitting equation:CUSUM(n)=0.001n^(3)-0.099n^(2)+2.466n-3.669(where n represents the number of cases).The fitted curve reached its peak at 17 cases.Before reaching 17 cases,the CUSUM curve exhibited a continuous upward trend,while after surpassing 17cases,it demonstrated a consistent decline.Based on this demarcation point,the learning curve can be divided into two distinct stages:the initial learning stage encompassing cases one to seventeen and the subsequent proficiency stage beyond 17 ases.Compared with the learning and the proficiency stage,there was no statistical difference in baseline data between the two groups,and there were statistically significant differences in operation time(P=0.003),intraoperative blood loss(P=0.002),postoperative feeding time(P=0.005),and the number of drainage tubes(P<0.001).Conclusion:The CUSUM method was employed to analyze the learning curve associated with RISON.The results showed that the cumulative number of operations required to master the technique was 17.
作者
程强
高帆
陈文政
艾青
江彬
卢崯
唐金路
沈诞
李宏召
Cheng Qiang;Gao Fan;Chen Wenzheng;Ai Qing;Jiang Bin;Lu Yin;Tang Jinlu;Shen Dan;Li Hongzhao(Senior Department of Urology,the Third Medical Center of PLA General Hospital,Beijing 100039,China;People's Liberation Army Medical College,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China)
出处
《微创泌尿外科杂志》
2023年第6期365-369,共5页
Journal of Minimally Invasive Urology
基金
国家重点研发计划(2022YFC3602900)
解放军总医院青年自主创新科学基金扶持项目(22QN-FC047)
关键词
膀胱肿瘤
学习曲线
尿流改道术
urinary bladder neoplasms
learning curve
urinary diversion
