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目的探讨同一组术者行腹腔镜辅助直肠癌根治术的学习曲线,总结腹腔镜辅助直肠癌手术经验。方法回顾性分析2010年1月至2015年12月期间笔者所在医院科室同一组术者连续开展的119例腹腔镜辅助直肠癌根治术患者的临床资料,对于每一例患者的手术时间,采用加权移动平均法、累及分析法(cumulative sum analysis,CUSUM)、风险调整累及分析法(risk-adjusted CUSUM,RA-CUSUM)以及曲线拟合软件Matlab分析学习曲线;再通过比较学习曲线中每一阶段患者的手术时间、术中出血量、淋巴结检出个数、远端切缘距肿瘤下缘距离、并发症发生情况、术后住院时间以及术后首次进流食时间来验证近期疗效,总结腹腔镜辅助直肠癌的手术经验。结果该组医师行腹腔镜辅助直肠癌手术学习曲线分为3个阶段及2个时间截点,第1个截点是在完成手术第36例左右,第2个截点在完成手术第80例左右。3个阶段患者的一般资料比较其差异无统计学意义(P>0.05),但比较3个阶段患者的手术时间、术中出血量、淋巴结检出个数、远端切缘距肿瘤下缘距离、并发症发生情况和术后住院时间,其差异均有统计学意义(P<0.05),以第3阶段最优,第2阶段次之,第1阶段最差。结论腹腔镜辅助直肠癌根治术学习曲线可分为初步探索期、掌握期和熟练期;有丰富开腹直肠癌手术经验的该组固定手术团队腹腔镜辅助直肠癌手术达到掌握程度完成第1阶段需要36例左右,达到熟练程度完成第2阶段需80例左右,且在学习曲线不同阶段所完成手术的近期疗效有差异。
Objective To explore the learning curve of laparoscopic-assisted radical resection of rectal cancer in the same group of surgeons and to summarize the experience of laparoscopic assisted rectal cancer surgery. Methods The clinical data of 119 patients with laparoscopic assisted radical resection of rectum cancer underwent continuous operation from January 2010 to December 2015 were retrospectively analyzed. For each patient’s operation time, weighted moving Average curve, cumulative sum analysis (CUSUM), risk-adjusted CUSUM (RA-CUSUM) and curve fitting software Matlab analysis of learning curve; then by comparing the learning curve of patients in each stage Operative time, intraoperative blood loss, the number of lymph nodes detected, the distance from the distal edge of the distal margin of the tumor margin, the incidence of complications, postoperative hospital stay and the time of first inflow of fluid to verify the short-term efficacy, summary of laparoscopic assisted rectal Cancer surgery experience. Results The group’s laparoscopic assisted rectal cancer surgery learning curve was divided into three stages and two time cut-off points. The first cut-off point was about 36 cases after the completion of surgery, the second cut-off point was 80 cases about. There was no significant difference in the general data of the three stages (P> 0.05). However, the operation time, intraoperative blood loss, the number of lymph nodes and distal margin of the distal margin , Complications and postoperative hospital stay, the differences were statistically significant (P <0.05), the best in the third stage, the second stage second, the first stage of the worst. Conclusion Laparoscopic assisted radical resection of rectal cancer learning curve can be divided into initial exploration phase, mastery and proficiency; has extensive experience in surgery of open rectal cancer group of fixed surgical team laparoscopic assisted rectal cancer surgery to achieve the level of completion of the first phase Need about 36 cases, to achieve proficiency to complete the second phase of about 80 cases, and in the learning curve at different stages of the completion of the operation of the short-term effect is different.