经剑突下入路胸腔镜下前纵隔肿瘤切除术学习曲线分析  

Learning Curve of Subxiphoid Approach in Video-assisted Thoracoscopic for the Treatment of Anterior Mediastinal Tumor

作　　者：陈舒晨[1] 余绍斌 林济红[1] 杨国锋[1] 韩子阳[1] 康明强[1,2,3] 

机构地区：[1]福建医科大学附属协和医院胸外科,福建省胸心外科研究所,福州350001 [2]消化道恶性肿瘤教育部重点实验室,福州350122 [3]福建省肿瘤微生物重点实验室,福州350122

出　　处：《福建医科大学学报》2017年第5期311-315,共5页Journal of Fujian Medical University

基　　金：国家自然科学基金(81341006);福建省卫生和计划生育委员会中青年骨干人才培养项目(2016-ZQN-25);福建省高等学校新世纪优秀人才支持计划(2017B015)

摘　　要：目的探讨经剑突下入路胸腔镜下前纵膈肿瘤切除术的学习曲线和临床应用。方法收集经剑突下入路胸腔镜下前纵膈肿瘤切除术患者33例,按照手术日期的先后顺序分3组(A,B,C组),每组11例。比较各组患者的手术时间、术中出血量、中转开胸率、术后并发症、术后住院天数、纵膈引流量等,分析不同阶段的手术效果。结果 3组患者在性别、年龄、术前合并症、肿瘤大小、体质量指数、纵膈引流量、中转开胸率、术后住院天数、术后并发症、拔管时间等方面差别均无统计学意义(P>0.05)。A组的手术时间为(151.91±39.53)min(107~227min),显著长于B组(97.91±19.36)min(70~150min)和C组(77.27±10.88)min(55~100 min)(P<0.05)。A组的术中出血量为(39.09±26.25)mL(10~100mL),显著多于B组(20.73±12.28)mL(3~40mL)和C组(18.18±13.83)mL(5~50mL)(P<0.05)。结论微创腔镜技术经验丰富的手术医师经剑突下入路胸腔镜下前纵隔肿瘤切除术的学习曲线大约是11例。Objective To investigate the learning curve of subxiphoid approach in video-assisted thoracoscopic resection of anterior mediastinal tumor. Methods Retrospective analyses were conducted on the clinical data of 33 patients with anterior mediastinal tumor or myasthenia gravis,which underwent subxiphoid approach in video-assisted thoracoscopic. The subjects were chronologically divided into three groups（group A,group B,and group C）,with 11 cases in each group. The surgical duration,intraoperative blood loss,the rate of conversion to thoracotomy,complications,duration of hospital stay,and mediastinal drainage tube indwelling time were individually compared among the three groups. We then analyzed operational effects of different stages. Results The clinical date including gender,age,complications,size,BMI（body mass index）,mediastinal drainage,rate of conversion to thoracotomy,postoperative hospital stays,complications as well as mediastinum drainage tube indwelling time were all statistically not different among the three groups（P〉0.05）. The operation time of group A was between 107 and 227 minutes（151.91±39.53 min）,significantly longer than those of group B,which were between 70 and 150 minutes（97.91±19.36 min）and group C,which were between 55 and 100 minutes（77.27±10.88 min）,P〈0.05. The intraoperative blood loss was significantly more in group A（10-100 mL,39.09±26.25 mL）than in group B（3-40 mL,20.73±12.28 mL）and group C（5-50 mL,18.18±13.83 mL）,P〈0.05. Conclusion For surgeons with extensive experience in minimally invasive endoscopic techniques,the learning curve of subxiphoid approach in video-assisted thoracoscopic for the treatment of anterior mediastinal tumor is approximately 11 cases.

关 键 词：经剑突下入路 胸腔镜 前纵隔肿瘤 学习曲线 

分 类 号：R734.5[医药卫生—肿瘤]