后腹腔镜下输尿管上段切开取石术的学习曲线  

The learning curve of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi

作　　者：舒丙学 疏仁义[1] 黄进[1] 

机构地区：[1]池州市人民医院,安徽池州247000

出　　处：《现代泌尿外科杂志》2017年第3期210-212,240,共4页Journal of Modern Urology

摘　　要：目的评价后腹腔镜下输尿管上段切开取石术不同阶段的手术效果,探讨学习曲线,并总结手术过程中的难点及解决方案。方法回顾分析我院2014年4月至2016年3月完成的30例后腹腔镜下输尿管上段切开取石术的临床资料。按手术先后顺序分成3组(A、B、C组各10例),比较各组间临床资料、手术时间、术后最高体温、术后最大引流、术后拔管时长及出院时长的差异,绘制学习曲线图,分析手术稳定所需的手术例数。结果 30例均顺利完成,3组间年龄、性别、BMI、结石大小、手术侧别等方面均无统计学意义(P>0.05),手术时间A组(153.3±23.8)min,B组(132±19.3)min,C组(92.1±19.4)min,三组间手术时间逐渐缩短,差异有统计学意义(P<0.01)。三组间术后最高体温、术后最大引流、术后拔管时间、住院时间无显著差异(P>0.05)。学习曲线图可见,达到手术稳定所需的手术例数为25例。结论后腹腔镜下输尿管上段切开取石术是一种微创、安全、有效的手术治疗方式,在积累25例手术经验后即可达到较熟练的程度。Objective To evaluate the surgical effects of retroperitoneal laparoscopic ureterolithotomy （RLU） in the treatment of upper ureteral calculi in different stages, to investigate the learning curve, and to summarize the difficulties and solutions in the process of operation. Methods The clinical data of 30 patients undergoing RLU for upper ureteral calculi by the same surgical team during April 2014 and March 2016 were retrospectively analyzed. According to the operative sequence, the patients were divided into 3 groups： group A, B and C, with 10 cases in each group. The operation time, highest postoperative temperature, maximum postoperative drainage, extubation time, and hospital stays were compared. The learning curve was designed, and the number of cases needed for stable performance was analyzed. Results All operations were successful. There was no statistically significant difference in age, gender, BMI, calculi size, and surgical sides （P〉0.05）. The operation time for group A, B, and C was （153.3±23.8）min, （132±19.3）min, （92.1±19.4）min, respectively（P〈0.01）. There was no difference in the highest postoperative temperature, maximum postoperative drainage, extubation time, and hospital stays among the 3 groups. Conclusion Retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi is a minimally invasire, safe and effective approach. In our hospital, the learning curve needs approximately 25 cases.

关 键 词：后腹腔镜 切开取石 学习曲线 

分 类 号：R693.4[医药卫生—泌尿科学]