摘要
目的评价腹腔镜下胃底折叠术的手术效果以及在不同阶段的差异,探讨其学习曲线。方法对同一组术者连续开展的36例腹腔镜下胃底折叠术患者进行分析,对于每例患者的手术时间,采用累积和(CUSUM)分析法绘制腹腔镜胃底折叠书的学习曲线,比较学习曲线不同阶段的手术时间、术中出血量、术后胃肠功能恢复时间,反流性疾病问卷(RDQ)评分,消化病生活质量指数(GLQI)评分及不良反应发生率的差异。结果CUSUM法得出曲线最大转折点在19例处,以此为分界将学习曲线划分为学习提高、熟练掌握两个阶段,两个阶段患者的一般资料比较,差异无统计学意义(P>0.05);术者熟练掌握阶段患者的手术时间、术中出血量、术后胃肠功能恢复时间、术后6个月RDQ评分和GLQI评分均优于学习提高阶段(P<0.05)。结论通过CUSUM分析法对腹腔镜胃底折叠术的学习曲线进行精准剖析,表明术者驾驭该技术须累积的手术例数为19例。
Objective Explore the learning curve of laparoscopic Nissen fundoplication(LNF)for gastro-esophageal reflux disease,and evaluate the surgical effect of LNF and differences in different stages.Methods Patients(n=36)with LNF were recruited in the study.The cumulative sum analysis(CUSUM)was used to determine the learning curve of LNF for gastro-esophageal reflux disease.The learning curve in different stageswere compared by analyzing the operation time,blood loss,the postoperative recovery time,RDQ score,GLQI score and postoperative complication.Results The CUSUM method obtained the maximum turning point of the curve at 19 cases,which divided the learning curve into two stages:learning improvement and mastery.However,the general data of the two stages was not statistically significant(P>0.05).The operation time,blood loss,postoperative gastrointestinal function recovery time,RDQ score and GLQI score at postoperative 6-month were superior in mastery stage than those in learning improvement stage.Conclusion Accurate analysis of the learning curve of LNF for gastro-esophageal reflux disease by CUSUM showed that the required number of handling surgical procedure was 19.
作者
杜军
李俊生
费伯建
金留根
蒋晖
陈柏
谢立飞
Du Jun;Li Junsheng;Fei Bojian;Jin Liugen;Jiang Hui;Chen Bai;Xie Lifei(Department of Gastroenterological Surgery,Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of General Surgery,ZhongdaHospital,Southeast University,Nanjing 210009,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2021年第2期123-127,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
腹腔镜
胃底折叠术
胃食管反流病
学习曲线
Laparoscopic
Nissen fundoplication
Gastro-esophageal reflux disease
Learning curve
