摘要
目的:回顾性分析我院单一术者连续行腹腔镜膀胱癌根治术(LRC)患者的临床资料,评估学习曲线的影响。方法:我院2014年2月～2018年3月接受LRC患者118例,男98例,女20例;其中90例行回肠膀胱术,21例行输尿管皮肤造口术,7例行原位回肠新膀胱术。按时间顺序将病例分为3组(第1组第1～40例,第2组第41～80例,第3组第81～118例),比较3组的手术时间、术中出血等方面的差异。结果:3组患者平均手术时间为(295.59±56.59)min;平均术中出血为(353.64±163.19)ml。第1组、第2组和第3组的平均手术时间分别为(338.00±50.00)min、(283.50±50.55)min和(263.68±40.63)min,第1组与第2组比较差异有统计学意义(P<0.05),第2组与第3组比较差异无统计学意义(P>0.05)。第1组、第2组和第3组的平均出血量分别为(448.00±224.38)ml、(327.25±107.63)ml和(282.11±57.43)ml,术中出血量逐渐下降,而手术时间在40例后呈稳定趋势。结论:LRC治疗膀胱肿瘤是安全有效的,学习曲线相对陡峭。当达到40例手术的积累后,熟练程度明显提高。
Objective：To evaluate our experience and results of laparoscopic radical cystectomy（LRC）and assess the impact of learning curve on perioperative outcomes with LRC by a single-surgeon＇s experience in Peking Union Medical College Hospital.Method：Between February 2014 and March 2018,aprospective study in a single institute on patients with bladder cancer who underwent LRC was conducted.One hundred and eighteen patients（98 men and 20 women）underwent LRC during the 4-year study period.Ninety patients were submitted to ileal conduits,21 patients to ureterocutaneostomies,and 7 to neobladders.The patients were divided into 3 groups according to the time of operation.Operative parameters and perioperative complications were evaluated including operative time,blood loss and perioperative complications.Result：The mean operative time was（295.59±56.59）min,and the mean blood loss was（353.64±163.19）ml.The operative time was（338.00±50.00）,（283.50±50.55）and（263.68±40.63）minutes,respectively,for each group.The intraoperative blood loss was（448.00±224.38）,（327.25±107.63）and（282.11±57.43）ml,respectively,for each group.The intraoperative blood loss was gradually lowered from group one to group three.Significant decline of operative time occurred after every40 cases of LRC（P〈0.05）.Conclusion：LRC is a safe and efficient modality of treatment of bladder cancer.However,it comes with a steep learning curve.This report helps to define the learning curve for LRC and demonstrates an acceptable level of proficiency by the 40 th case.
作者
谢邁
纪志刚
乔逸
成向明
李嘉临
XIE Yi;JI Zhigang;QIAO Yi;CHENG Xiangming;LI Jialin(Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing,100730,China)
出处
《临床泌尿外科杂志》
2018年第11期855-858,864,共5页
Journal of Clinical Urology
关键词
膀胱癌
腹腔镜
膀胱切除术
学习曲线
bladder cancer
laparoscopy
cystectomy
learning curve
