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目的:腹腔镜膀胱全切手术因为创伤小、术后恢复快等优点在临床得到了越来越多的应用,本研究回顾性分析了北京大学第一医院单个外科医生60例腹腔镜膀胱全切手术的学习曲线,探讨如何缩短腹腔镜膀胱全切手术时间、减少出血、减少并发症,分析医生从第1例手术到熟练掌握手术技术的过程。方法:回顾性分析2004年5月至2012年1月北京大学第一医院单个外科医生完成的60例腹腔镜膀胱全切手术,其中女性9例,男性51例,平均年龄(60.8±11.4)岁,平均体重指数(body mass index,BMI)(23.9±2.7)kg/m2。按手术先后顺序分为A、B、C组,每组20例,比较3组的手术时间、术中出血、术后住院日等方面的差异。结果:平均术中出血为(799.2±717.8)mL,平均手术时间为(420.2±119.8)min;平均术后住院日为(15.7±11.0)d。3组患者在年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、BMI等方面差异均无统计学意义(P>0.05);手术时间A组(497.5±131.2)min、B组(413.6±75.6)min、C组(349.4±100.2)min,差异有统计学意义(P<0.001);术中出血A组(1 080.0±1 028.8)mL、B组(862.5±510.6)mL、C组(455.5±262.3)mL,差异有统计学意义(P=0.018);术后住院日A组(20.8±13.5)d、B组(16.4±10.6)d、C组(9.8±4.4)d,差异有统计学意义(P=0.005);而在术后并发症方面,3组之间差异无统计学意义。结论:腹腔镜膀胱全切手术例数的累积可以显著缩短手术时间,减少术中出血,缩短术后住院日。经过大约20例手术后,医生可以达到较熟练掌握手术技术的程度;经过大约40例手术后,医生的手术熟练和稳定程度明显提高。
OBJECTIVE: Laparoscopic total tamponotomy has gained more and more clinical applications because of its advantages such as less trauma and faster postoperative recovery. This study retrospectively reviewed 60 cases of laparoscopic total cystectomy of a single surgeon in Peking University First Hospital Surgical learning curve to explore how to shorten the laparoscopic total cystectomy surgery time, reduce bleeding, reduce complications, analysis of the doctor from the first case of surgery to master the process of surgical techniques. Methods: A total of 60 laparoscopic total hysterectomy performed by a single surgeon at Peking University First Hospital from May 2004 to January 2012 were retrospectively analyzed, including 9 females and 51 males, with an average age of 60.8 ± 11.4 years , Body mass index (BMI) (23.9 ± 2.7) kg / m2. According to the order of operation, the patients were divided into A, B and C groups, with 20 cases in each group. The differences of operation time, intraoperative bleeding and postoperative hospital stay were compared. Results: The mean intraoperative bleeding was (799.2 ± 717.8) mL, the mean operative time was (420.2 ± 119.8) min. The average postoperative hospital stay was (15.7 ± 11.0) days. There was no significant difference in age, AAS score and BMI between the three groups (P> 0.05). The time of operation in group A (497.5 ± 131.2) min, group B (413.6 (P <0.001). The intraoperative hemorrhage in group A was (1080.0 ± 10282) mL, in group B (862.5 ± 510.6) mL, in group C (455.5 ± 262.3) mL, the difference was statistically significant (P = 0.018); The postoperative hospital stay in group A was (20.8 ± 13.5) days, in group B (16.4 ± 10.6) days and in group C There was statistical significance (P = 0.005); while in postoperative complications, there was no significant difference between the three groups. Conclusion: The total laparoscopic total cystectomy surgery can significantly reduce the operation time, reduce intraoperative bleeding and shorten the postoperative hospital stay. After about 20 surgeries, the surgeon can achieve a more proficient surgical technique; after about 40 surgeries, the doctor’s skill and stability are significantly improved.