单一术者连续118例腹腔镜膀胱癌根治术学习曲线分析

谢邁; 纪志刚; 乔逸; 成向明; 李嘉临

doi:10.13201/j.issn.1001-1420.2018.11.002

单一术者连续118例腹腔镜膀胱癌根治术学习曲线分析

- 中国医学科学院北京协和医学院北京协和医院泌尿外科(北京, 100730)

详细信息

通讯作者: 纪志刚:E-mail:jzg1129@medmail.com.cn

中图分类号: R737.14

收稿日期: 2018-09-18

Learning curve of laparoscopic radical cystectomy for a single surgeon of 118 consecutive cases

- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China

More Information

Corresponding author: JI Zhigang, E-mail: jzg1129@medmail.com.cn

Received Date: 18 September 2018

摘要

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。
- 膀胱癌 /
- 腹腔镜 /
- 膀胱切除术 /
- 学习曲线
Abstract: 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.
- bladder cancer /
- laparoscopy /
- cystectomy /
- learning curve

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