摘要
目的:分析单一手术团队经自然腔道取标本的腹腔镜直肠及乙状结肠癌根治术的学习曲线。方法:回顾分析2015年10月至2018年2月经自然腔道取标本的腹腔镜直肠及乙状结肠癌根治术连续100例患者的临床资料,利用累积求和法分析其学习曲线,并对比度过学习曲线前后的临床病理特征、手术情况、术后恢复情况、围手术期并发症发生率。结果:手术时间平均(152.5±34.1) min,肿瘤直径平均(3.4±1.1) cm,其中78例(78%)经直肠取出标本,22例(22%)经阴道取出标本。无术后30 d死亡病例。3例(3%)发生吻合口漏,2例(2%)发生泌尿系感染。经自然腔道取标本的腹腔镜直肠及乙状结肠癌根治术的学习曲线可分为两个阶段,44例后被认为度过学习曲线,手术时间由(168.8±36.0) min降至(139.6±26.5) min(P<0.001),术后首次进食时间由(5.0±0.8) d降至(4.4±0.8) d(P<0.001),住院时间由(8.9±4.9) d降至(7.5±2.0) d(P<0.05),术中出血量、淋巴结清扫数量、术后首次排气排便时间及围手术期并发症发生率差异均无统计学意义。结论:经自然腔道取标本的腹腔镜直肠及乙状结肠癌根治术的学习过程安全,适合具有腹腔镜下结直肠癌根治经验的手术团队开展。
Objective:To analyze the learning curve of laparoscopic rectal and sigmoid cancer radical resection with natural orifice specimen extraction completed by the same surgical team.Method:The clinical data of consecutive 100 patients who underwent laparoscopic rectal or sigmoid cancer radical resection with natural orifice specimen extraction from Oct.2015 to Feb.2018 were retrospectively analyzed.The learning curve was analyzed by cumulative summation method,the clinicopathological features,operative characteristics,postoperative recovery and perioperative complications rate were compared between the two study periods.Results:Average operative time was(152.5±34.1)min,average tumor diameter was(3.4±1.1)cm,78 patients(78%)underwent transanal specimen extraction and the other 22 patients(22%)underwent transvaginal specimen extraction.No death occurred within 30 d after operation.3 cases(3%)developed anastomotic leakage and 2(2%)developed urinary tract infection.According to cumulative summation method,laparoscopic radical resection for rectal and sigmoid cancer with natural orifice specimen extraction could be divided into 2 learning phases.After 44 cases were considered to get through the learning curve period.The average operative time decreased from(168.8±36.0)min to(139.6±26.5)min(P<0.001),the time of first oral feeding decreased from(5.0±0.8)d to(4.4±0.8)d(P<0.001)and hospital stay decreased from(8.9±4.9)d to(7.5±2.0)d(P<0.05).There were no significant differences in blood loss,number of harvested lymph nodes,time to first flatus and defecation or rate of perioperative complication between the two periods.Conclusions:It is safe to study laparoscopic radical resection for rectal and sigmoid cancer with natural orifice specimen extraction.More surgical teams which have experiences of laparoscopic colorectal tumor excision can carry out this technique.
作者
张明光
周海涛
梁建伟
关旭
卢召
刘正
姜争
刘骞
郑朝旭
王锡山
ZHANG Ming-guang;ZHOU Hai-tao;LIANG Jian-wei(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100021,China)
出处
《腹腔镜外科杂志》
2018年第11期813-818,共6页
Journal of Laparoscopic Surgery
基金
国家重点研发计划精准医学研究专项(编号:2016YFC0905300)
国家重点研发计划(编号:2017YFC0908203)
北京市科技计划(编号:D171100002617004)
中国医学科学院医学与健康科技创新工程项目(编号:2016-I2M-1-001,编号:2017-I2M-2-003)
