Analysis of learning curve and curative effect of transumbilical single site laparoscopic radical nephrectomy by one single surgeon
-
摘要: 目的 探究单一术者行经脐单孔腹腔镜肾根治性切除术的学习曲线分析及疗效分析。方法 回顾性分析南京中医药大学附属医院泌尿外科2019年12月—2021年3月由同一手术医师连续完成的100例行经脐单孔腹腔镜肾根治性切除术患者的临床资料。按手术的先后顺序，将患者分为A、B、C、D、E组(A组即第1阶段组为第1~20例，B组即第2阶段组为第21~40例，C组即第3阶段组为第41~60例，D组即第4阶段组为第61~80例，E组即第5阶段组为第81~100例)，对比各组患者手术时间、术中出血量、术中中转率、引流管留置时间、术后并发症、住院时间。结果 各组患者年龄、性别、BMI等比较差异无统计学意义(P>0.05)。与A组患者比较，B组患者手术时间、引流管留置时间和住院时间均明显缩短，术中出血量、中转率和术后并发症发生率明显降低，差异有统计学意义(P < 0.05)。B组和C组患者手术时间和术中出血量比较差异有统计学意义(P < 0.05)。C组、D组和E组患者手术时间、术中出血量、术中中转率、引流管留置时间、术后并发症、住院时间等指标比较差异均无统计学意义(P>0.05)。结论 经脐单孔腹腔镜肾根治性切除术具有良好的安全性和可行性，随着手术经验的积累，患者手术时间，引流管留置时间和住院时间均显著缩短，术中出血量、中转率和术后并发症发生率均明显降低。学习曲线约为40例。Abstract: Objective To explore the learning curve analysis and curative effect analysis of transumbilical single site laparoscopic radical nephrectomy.Methods The clinical data of 100 patients with transumbilical single site laparoscopic radical nephrectomy completed by the same surgeon in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2019 to March 2021 were analyzed retrospectively. Patients were divided into 5 groups in chronological order: group A (group in stage 1) included cases 1-20, group B (group in stage 2) included cases 21-40, group C (group in stage 3) included cases 41-60, group D(group in stage 4) included cases 61-80 and group E (group in stage 5) included cases 81-100. The operation time, intraoperative bleeding, intraoperative conversion rate, indwelling time of drainage tube, postoperative complications and hospital stay were compared.Results There was no significant difference in age, sex or BMI index among the groups (P > 0.05). Compared with group A, the operation time, indwelling time of drainage tube and hospital stay in group B were significantly shortened, and the amount of intraoperative bleeding, conversion rate and incidence of postoperative complications were significantly reduced (P < 0.05). There was significant difference in operation time and intraoperative bleeding between group B and group C (P < 0.05). There was no significant difference in operation time, intraoperative bleeding, intraoperative conversion rate, indwelling time of drainage tube, postoperative complications or hospital stay among group C, group D and group E (P > 0.05).Conclusion Transumbilical single site laparoscopic radical nephrectomy has good safety and feasibility. With the accumulation of surgical experience, the operation time, drainage tube retention time and hospital stay are significantly shortened, and the amount of intraoperative bleeding, conversion rate and postoperative complication rate are significantly reduced. The learning curve was about 40 cases.
-
-
表 1 患者术中出血量、中转率和引流管留置时间资料比较
X ± S 组别 例数 术中出血量
/mL中转/
例(%)引流管留置
时间/dA组 20 31.67±13.67 7(35.00) 4.76±1.28 B组 20 23.85±10.341) 1(5.00)1) 3.17±1.031) C组 20 16.97±10.941)2) 1(5.00)1) 2.86±1.141) D组 20 15.77±8.961)2) 01) 2.59±1.091) E组 20 15.46±9.061)2) 1(5.00)1) 2.64±1.071) t/Z 11.640 16.030 19.860 P值 0 0.001 0 与A组比较，1)P < 0.05;与B组比较，2)P < 0.05。 
下载: 导出CSV
-
[1] 吴中华, 刘同族, 王行环, 等. 单孔与标准后腹腔镜肾切除术治疗无功能积水肾的对比研究[J]. 现代泌尿外科杂志, 2019, 24(5): 385-388. doi: 10.3969/j.issn.1009-8291.2019.05.012
[2] Habicher M, Tokas T, Herrmann TR, et al. Laparoscopic single-incision triangulated umbilical surgery(SITUS)pyeloplasty: a description of the first 32 cases[J]. World J Urol, 2018, 36(11): 1883-1888. doi: 10.1007/s00345-018-2308-5
[3] 胡跃世, 李明林, 曹志华, 等. 腹腔镜肾部分切除术与开放性肾部分切除术治疗复杂性肾肿瘤的疗效对比[J]. 实用医院临床杂志, 2019, 16(1): 154-157. doi: 10.3969/j.issn.1672-6170.2019.01.050
[4] LaMattina JC, Alvarez-Casas J, Lu I, et al. Robotic-assisted single-port donor nephrectomy using the da Vinci single-site platform[J]. J Surg Res, 2018, 222: 34-38. doi: 10.1016/j.jss.2017.09.049
[5] 马凯, 侯泽斌, 段亚飞, 等. 单孔腹腔镜胆囊切除术助手学习曲线的探讨[J]. 腹腔镜外科杂志, 2020, 25(10): 761-765. https://www.cnki.com.cn/Article/CJFDTOTAL-FQJW202010010.htm
[6] 时佳子, 王志军, 琚官群, 等. 机器人单孔腹腔镜根治性膀胱切除术的初步疗效分析(附9例报告)[J]. 中华泌尿外科杂志, 2020, 41(11): 811-814. doi: 10.3760/cma.j.cn112330-20200807-00586
[7] Yu LJ, Su BL, Shan WY, et al. Single-Site Umbilical Laparoscopic Pyloromyotomy Using a Pyloric Electrocoagulation Chisel Combined with a Left-Handed Main Operation for Congenital Hypertrophic Pyloric Stenosis[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(11): 1248-1252. doi: 10.1089/lap.2020.0478
[8] 王晓樱, 李妍. 改良经脐单孔腹腔镜子宫肌瘤剔除术[J]. 中国微创外科杂志, 2019, 19(10): 919-921. doi: 10.3969/j.issn.1009-6604.2019.10.014
[9] 尹飞飞, 李学民, 段希斌, 等. 日间经脐单孔腹腔镜胆囊切除术65例单中心临床疗效分析[J]. 中华普通外科杂志, 2019, 34(8): 712-713.
[10] Bruintjes M, van Helden EV, de Vries M, et al. Chronic pain following laparoscopic living-donor nephrectomy: Prevalence and impact on quality of life[J]. Am J Transplant, 2019, 19(10): 2825-2832. doi: 10.1111/ajt.15350
[11] 杜巍, 徐伟东, 杨悦, 等. 多种路径机器人辅助单孔腹腔镜根治性前列腺切除术的初步疗效[J]. 中华泌尿外科杂志, 2020, 41(11): 815-819. doi: 10.3760/cma.j.cn112330-20200909-00657
[12] 朱建平, 牟东成, 薛晨辉, 等. 常规器械行经脐单孔腹腔镜胆囊切除术[J]. 中国微创外科杂志, 2019, 19(8): 702-704. doi: 10.3969/j.issn.1009-6604.2019.08.009
[13] 夏开国, 葛庆宇, 宣强, 等. 改良后腹腔镜解剖性肾上腺切除术学习曲线分析[J]. 临床泌尿外科杂志, 2019, 34(8): 634-637. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201908011.htm
[14] 孙力, 张旋, 杨萌, 等. 经脐单孔腹腔镜手术治疗巨大附件良性肿瘤30例[J]. 中国微创外科杂志, 2019, 19(4): 308-310. doi: 10.3969/j.issn.1009-6604.2019.04.005
[15] 庄惠强, 邓超雄, 邓丽, 等. 累积求和分析法研究后腹腔镜输尿管切开取石术的学习曲线[J]. 现代泌尿外科杂志, 2019, 24(11): 914-917. doi: 10.3969/j.issn.1009-8291.2019.11.009
[16] 李峰, 刘晗, 徐建威, 等. 单孔腹腔镜腹膜后清创术在感染坏死性胰腺炎治疗中的应用[J]. 中华肝胆外科杂志, 2020, 26(4): 281-285. doi: 10.3760/cma.j.cn113884-20190712-00218
[17] 王亚楠, 邓海军, 谢文谦, 等. 单孔腹腔镜辅助经肛全直肠系膜切除术治疗超低位直肠癌[J]. 中华胃肠外科杂志, 2019, 22(3): 285-291. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202132017.htm
[18] 徐辉, 张国玺, 邹晓峰, 等. 耻骨上辅助经脐单孔腹腔镜下肾切除术: 单中心学习曲线研究[J]. 中华泌尿外科杂志, 2016, 37(8): 572-577. doi: 10.3760/cma.j.issn.1000-6702.2016.08.003
[19] 刘悦泽, 邱江东, 郭俊超, 等. 单中心腹腔镜胰体尾切除术学习曲线分析[J]. 腹腔镜外科杂志, 2019, 24(9): 661-664. https://www.cnki.com.cn/Article/CJFDTOTAL-FQJW201909008.htm
[20] 高攀, 揭志刚, 李正荣, 等. 手辅助腹腔镜与腹腔镜辅助胃癌根治术的临床对照研究[J]. 实用医学杂志, 2019, 35(8): 1292-1295. doi: 10.3969/j.issn.1006-5725.2019.08.021
[21] 高京海, 张育佼, 金志军, 等. 机器人辅助单孔腹腔镜实施妇科恶性肿瘤手术技巧的探讨[J]. 解放军医学杂志, 2019, 44(7): 615-619. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY201907014.htm
[22] 李梦, 任明扬, 徐庆, 等. 腹腔镜直肠癌经肛全直肠系膜切除术学习曲线的多中心研究[J]. 中华消化外科杂志, 2021, 20(3): 306-314. doi: 10.3760/cma.j.cn115610-20201229-00812
-
图(2)
表(1)
计量
- 文章访问数: 1062
- PDF下载数: 540
- 施引文献: 0