经阴道NOTES辅助腹腔镜肾切除术学习曲线:单中心经验  

Learning curve of transvaginal natural orifice transluminal endoscopic surgery-assisted laparoscopic nephrectomy:one-center experience

作　　者：江波[1] 徐瑞权[1] 邹晓峰[1] 张国玺[1] 袁源湖[1] 肖日海[1] 薛义军[1] 伍耿青[1] 王晓宁[1] 刘佛林[1] 龙大治[1] 吴玉婷[1] 杨军[1] 刘全亮[1] 黎衍敏[1] JIANG Bo XU Ruiquan ZOU Xiaofeng ZHANG Guoxi YUAN Yuanhu XIAO Rihai XUE Yijun WU Gengqing WANG Xiaoning LIU Folin LONG Dazhi WU Yuting YANG Jun LIU Quanliang LI Yanmin(Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China)

机构地区：[1]赣南医学院第一附属医院泌尿外科,赣南医学院泌尿外科研究所,江西赣州341000

出　　处：《临床泌尿外科杂志》2017年第3期170-173,177,共5页Journal of Clinical Urology

基　　金：国家高技术研发计划(863计划)项目(编号2012AA021100);江西省"赣鄱英才555工程"领军人才培养计划项目;江西省科技厅重大科技支撑计划项目(编号20121BBG70032;20132BAB205007);江西省科技厅科技支撑计划项目(编号20151BBG70070);江西省教育厅科技落地计划项目(编号KJLD12044);江西省卫生厅科技计划项目(编号20111074;20121095);江西省高校"十二五"重点学科建设经费资助项目;江西省卫生计生委科技计划项目(编号20175361)

摘　　要：目的:探讨经阴道自然腔道内镜手术(NOTES)辅助腹腔镜单纯肾切除术的学习曲线。方法:回顾性分析我院2010年5月~2013年7月由同一位熟练掌握泌尿外科标准腹腔镜技术的术者连续施行的90例经阴道NOTES辅助腹腔镜单纯肾切除术临床资料。按手术先后顺序分为6组(A、B、C、D、E、F组),每组15例;比较各组手术时间、术中出血量、中转标准腹腔镜或开放手术率、术中及术后并发症发生率、术后肠蠕动恢复及腹腔引流管留置时间、术后住院时间等。结果:A、B组手术时间和术中出血量均显著大于C、D、E、F组(P<0.05);而A、B组之间,C、D、E、F组间差异均无统计学意义(P>0.05)。与A、B组比较,C、D、E、F组中转手术率、术中及术后并发症发生率均有所下降,但差异无统计学意义(P>0.05)。肠蠕动恢复时间、术后腹腔引流管留置时间和术后住院时间各组间差异均无统计学意义(P>0.05)。结论:对于已熟练掌握标准腹腔镜肾切除术的资深泌尿外科医生,完成约30例经阴道NOTES辅助腹腔镜单纯肾切除术后,学习曲线趋于平缓。Objective：To investigate the learning curve of transvaginal natural orifice transluminal endoscopic surgery（NOTES）-assisted laparoscopic simple nephrectomy.Method：A retrospective analysis was carried out on the clinical data of 90 consecutive patients who underwent transvaginal NOTES-assisted laparoscopic simple nephrectomy by a urologist with advanced laparoscopic skills from May 2010 to July 2013 in our center.The patients were divided into six groups（group A,B,C,D,E and F,with 15 cases in each group）by operative sequence.The operation time,estimated blood loss,recovery time of gastrointestinal function,intraoperative and postoperative complications,conversion to standard laparoscopic or open surgery,the time for drainage and postoperative hospital stay were compared among the six groups.Result：The operation time and estimated blood loss in groups A and B were significantly greater than those in group C,D,E and F（P〈0.05）,but no significant difference was found between group A and B or among group C,D,E and F（P〉0.05）.The rate of conversion to standard laparoscopic or open surgery,intraoperative and postoperative complications decreased in group C,D,E and F compared with group A and B,but the difference was not statistically significant（P〈0.05）.No significant difference was found in recovery time of gastrointestinal function,the time for drainage or postoperative hospital stay（P〉0.05）.Conclusion：For a urologist with advanced laparoscopic skills,the learning curve of transvaginal NOTES-assisted laparoscopic simple nephrectomy would tend to flatten out after completing about 30 cases.

关 键 词：经自然腔道内镜手术 经阴道途径 肾切除术 学习曲线 

分 类 号：R699.2[医药卫生—泌尿科学]