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摘要: 目的：探讨后腹腔镜肾部分切除术治疗局限性肾癌的学习曲线。方法：回顾性分析我院同一组医师连续开展的40例后腹腔镜肾部分切除术患者的临床资料：按手术先后将40例患者依次分为A组（1~10例）、B组（11~20例）、C组（21~30例）和D组（31~40例），比较各组术中出血量、肾热缺血时间、手术时间、胃肠道功能恢复时间、并发症、术后住院时间等指标。结果：四组患者术中出血量、肾热缺血时间和手术时间差异有统计学意义（P<0.05）；进一步两两比较发现A组的出血量、肾热缺血时间和手术时间与B组、C组和D组比较，差异有统计学意义（P<0.05），B组的出血量、肾热缺血时间和手术时间与C组和D组比较，差异有统计学意义（P<0.05），而C组的出血量、肾热缺血时间和手术时间与D组比较，差异无统计学意义（P>0.05）。各组患者术后胃肠道功能恢复时间、并发症发生率、术后住院时间比较，差异无统计学意义（P>0.05）。结论：后腹腔镜肾部分切除术的学习曲线大约为20例，即能达到比较熟练的水平和稳定的程度。Abstract: Objective: To explore the learning curve of retroperitoneal laparoscopic partial nephrectomy for localized renal cell carcinoma.Method: A retrospective analysis was made in 40 patients with localized renal cell carcinoma who underwent laparoscopic partial nephrectomy continuously by a single group of surgeons in our hospital. The patients were sequentially divided into group A (1-10 cases), group B (11-20 cases), group C (21-30 cases) and group D (31-40 cases). Clinical data including blood loss, warm ischemia time, operation time, recovery time of gastrointestinal function, complication rate and postoperative hospital stay were compared among them.Result: Differences of the amount of blood loss, renal warm ischemia time and operation time among four groups were significant (P<0.05). By multiple comparison, differences of the amount of blood loss, renal warm ischemia time and operation time between group A and group B, group C, group D were significant (P<0.05). Differences of the amount of blood loss, renal warm ischemia time and operation time between group B and group C, group D were significant (P<0.05). There was no significant differences of the amount of blood loss, renal warm ischemia time and operation time between group C and group D (P>0.05). There were no statistical differences in the recovery time of gastrointestinal function, complication rate and postoperative hospital stay among four groups (P>0.05).Conclusion: The learning curve for retroperitoneal laparoscopic partial nephrectomy usually comprises 20 procedures, then surgeons may be skilled in this technique.
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Key words:
- renal cell carcinoma /
- retroperitoneal laparoscopy /
- partial nephrectomy /
- learning curve
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