腹腔镜经腹腹膜前疝修补术治疗腹股沟疝学习曲线  

The learning curve of laparoscopic transabdominal preperitoneal repair for inguinal hernia

作　　者：王海江[1] 敬亚恒 周力波[1] 常帅[1] 仇广林[1] 贺仕才[1] 卢婧[1] 樊林[1] 贾宗良[1] 车向明[1] 

机构地区：[1]西安交通大学第一附属医院普通外科,西安710061

出　　处：《中华疝和腹壁外科杂志（电子版）》2017年第6期407-412,共6页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：国家自然科学基金(81472245)

摘　　要：目的探讨不同年资外科医师腹腔镜经腹腹膜前疝修补术(TAPP)的学习曲线。方法回顾性分析2013年1月至2015年12月,西安交通大学第一附属医院3位不同年资外科医师连续开展的210例TAPP术患者的临床资料,按手术日期先后对每例患者手术时间,使用移动加权平均法、累积和法,借助Prism软件得到学习曲线;再通过分析比较各级医师学习曲线完成前后患者手术时间、术中出血量、中转手术率、术后并发症发生情况、术后住院时间等近期手术效果验证学习曲线结果。结果不同年资医师完成TAPP术的学习曲线时间有所不同。各年资医师在学习曲线完成前行TAPP术患者的一般资料无统计学差异,但手术时间、术中出血量、中转手术率、术后并发症发生情况、术后住院时间有统计学差异(P<0.05);各年资医师在学习曲线完成后行TAPP术患者的一般资料、手术时间、术中出血量、中转手术率、术后并发症发生情况、术后住院时间均无明显统计学差异(P>0.05)。结论腹腔镜经腹腹膜前腹股沟疝修补术学习曲线主任医师为15例左右,副主任医师为20例左右,高年资主治医师为25例左右。Objective To investigate the learning curve of laparoscopic transabdominal preperitoneal （TAPP） repair for inguinal hernia of different seniority surgeons. Methods The clinical data of 210 cases of inguinal hernia treated by TAPP which operated by three different seniority surgeons from December 2013 to December 2015 in department of general surgery, the first affiliated hospital, medical school of Xi＇an Jiaotong university were analyzed retrospectively. Using moving average methods, CUSUM, and PRISM software to obtain the learning curve according every patient＇s operation time ranked by operation date. Then we compared different seniority surgeons by contrasting the short - term effects before and after complete the curve, such as operation time, intraoperative bold loss, conversion to open surgery, postoperative complications, postoperative hospital stay, to testify our consequences. Result Different seniority surgeons had different learning curve of TAPP. There were no statistical difference in general data and preoperative indexes before and after complete the learning curve, while the differences among operation time, blood loss, conversion to open surgery rate, postoperative complications, postoperative hospital stay and recurrence rate were significant （P 〈 0.05 ）. There were no statistical difference in general data among different seniority surgeons before complete the learning curve, while the differences among operation time, blood loss, conversion to open surgery rate, postoperative complications, postoperative hospital stay and recurrence rate were significant （ P 〈 0. 05 ）. There were no statistical difference in general data and operation time, blood loss, conversion to open surgery rate, postoperative complications, postoperative hospital stay and recurrence rate among different seniority surgeons after complete the learning curve （P 〉0.05）. Conclusion The learning curve of TAPP repair for senior doctor is approximately 15 cases, associate doctor is 20 cases, and superior

关 键 词：疝 腹股沟 疝修补术 学习曲线 加权移动平均法 

分 类 号：R656.21[医药卫生—外科学]