摘要
目的:腹腔镜膀胱全切手术因为创伤小、术后恢复快等优点在临床得到了越来越多的应用,本研究回顾性分析了北京大学第一医院单个外科医生60例腹腔镜膀胱全切手术的学习曲线,探讨如何缩短腹腔镜膀胱全切手术时间、减少出血、减少并发症,分析医生从第1例手术到熟练掌握手术技术的过程。方法:回顾性分析2004年5月至2012年1月北京大学第一医院单个外科医生完成的60例腹腔镜膀胱全切手术,其中女性9例,男性51例,平均年龄(60.8±11.4)岁,平均体重指数(body mass index,BMI)(23.9±2.7)kg/m2。按手术先后顺序分为A、B、C组,每组20例,比较3组的手术时间、术中出血、术后住院日等方面的差异。结果:平均术中出血为(799.2±717.8)mL,平均手术时间为(420.2±119.8)min;平均术后住院日为(15.7±11.0)d。3组患者在年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、BMI等方面差异均无统计学意义(P>0.05);手术时间A组(497.5±131.2)min、B组(413.6±75.6)min、C组(349.4±100.2)min,差异有统计学意义(P<0.001);术中出血A组(1 080.0±1 028.8)mL、B组(862.5±510.6)mL、C组(455.5±262.3)mL,差异有统计学意义(P=0.018);术后住院日A组(20.8±13.5)d、B组(16.4±10.6)d、C组(9.8±4.4)d,差异有统计学意义(P=0.005);而在术后并发症方面,3组之间差异无统计学意义。结论:腹腔镜膀胱全切手术例数的累积可以显著缩短手术时间,减少术中出血,缩短术后住院日。经过大约20例手术后,医生可以达到较熟练掌握手术技术的程度;经过大约40例手术后,医生的手术熟练和稳定程度明显提高。
Objective： To evaluate the changes in perioperative outcomes that might refect progress along the learning curving by a single-surgeon＇ s experience in our institution with laparoscopic radical cystectomy （LRC）. Methods： This report was conducted between May 2004 and January 2012 in 60 patients （9 women and 51 men） who underwent LRC for bladder cancer. The mean patient age was （60.8 ± 11.4） years, and mean BMI was （23.9 ± 2.7 ） kg/m2. We divided the patients into 3 groups （group A, group B, and group C; each group had twenty patients） by the time, and compared the operative time, intraoperative blood loss, hospital stay among the three groups. Results： The mean intraoperative blood loss was （799.2 ±717.8） mL, the mean operative time was （420.2 ± 119.8） minutes, and the mean hospital stay was （ 15.7 ± 11.0 ） d ; There was no statistically significant difference in age, American Society of Ansthesiologists （ASA） scores and BMI among the three groups （P 〉 0.05 ）. Their operative time was （497.5 ± 131.2）, （413.6 ±75.6） and （349.4 ± 100.2） minutes, respectively, for each group, P 〈0. 001. The intraoperative blood loss was （ 1 080.0 ± 1 028.8）, （862.5 ±510.6） and （455.5 ± 262.3） mL, for each group, P = 0. 018. The hospital stay was （20.8 ± 13.5 ）, （ 16.4 ± 10.6） and （9.8 ±4.4） d, for each group, P =0. 005. However, there was no statistically significant difference in postoperative complications among the three groups. Conclusion： Our experience of LRC appears to be favorable with reduction in blood loss, operative time and hospital stay with increasing experience. The curving shows a significant decline at 2 different breakpoints： after the first 20 cases, and after 40 cases.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第4期558-562,共5页
Journal of Peking University:Health Sciences
