食管癌切除术学习曲线影响术后瘘的发生率  

Learning curve of esophagectomy for esophageal cancer affects postoperative fistula rates

作　　者：熊宏超[1] 付浩[1] 杨合利 秦斌[1] XIONG Hong-chao , FU Hao , YANG He-li , QIN Bin(Department of Thoracic Surgery I ,Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education） ,Peking University School of Oncology ,Beijing Cancer Hospital ,Beijing 100142,P. R. China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胸外一科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华肿瘤防治杂志》2018年第3期197-200,206,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的食管癌切除术是胸外科大型复杂手术,学习曲线长,术后并发症尤其是瘘长期困扰医生及患者,本研究探讨食管癌切除术学习曲线与术后瘘发生率的关系。方法回顾性分析2009-12-16-2015-12-31北京大学肿瘤医院单一手术组完成的90例食管癌切除术患者的临床资料。按手术时间的先后顺序分成A组21例、B组24例和C组45例,比较各组术后瘘发生率及手术相关因素。结果术后瘘发生率A、B、C组分别为28.6%、29.2%和8.9%,差异有统计学意义,P=0.047。手术时间A组为(322.9±47.3)min,显著长于B组的(264±24.1)min和C组的(277±33.9)min,差异有统计学意义,P<0.001。出血量A组为(302.4±84.4)mL,B组为(206±66.5)mL,C组明显降低为(158.9±52.5)mL,差异有统计学意义,P<0.001。术后住院时间A组(20.7±10.0)d,B组(21.4±12.8)d,C组则减少为(13.6±3.1)d,差异有统计学意义,P<0.001。结论食管癌切除术的学习曲线与术后瘘的发生率密切相关,学习初期术后瘘的发生率较高,随着学习曲线的完成而逐渐下降。胸外科医生应循序渐进,总结经验教训,提高手术技能,从而降低术后瘘的发生率。OBJECTIVE Esophagectomy for esophageal cancer is a large and complicated thoracic operation, with long learning curve. Postoperative complications, especially fistula, has been disturbing doctors and patients. Hence, we investigated the relationship between learning curve of esophagectomy and postoperative fistula rates. METHODS We ret rospectively analyzed 90 patients with esophageal cancer who underwent esophagectomy by the author independently from December 16,2009 to December 31,2015 in Beijing Cancer Hospital. In order of the date of surgery, the patients were equally divided into groups A,B and C by every two years,with 21 cases in group A,24 in group B and 45 in group C. Comparisons were made among the three groups on postoperative fistula rates and possible risk factors. RESULTS The post operative fistula rates in group A and B were 28.6% and 29.2% ,while group C was 8.9% ,which was significantly lower than A and B（P 0. 047）. The operation time was significantly longer in group A than B and C, respectively （322.9 47.3） min,（264±24. 1） min and （277±33. 9） rain （P〈0. 001）. The blood loss of surgery in group A and B were （302.4±84.4） mL and （206±66.5） mL,while group C was （158.9±52.5） mL,which was significantly lower than that in A and B（P〈0. 001）. The hospital stay after operation in group A and B were （20.7±10.0） d and （21.4±12.8） d, while group C was reduced to （13. 6±3. 1） d, which was significantly lower than that in A and B（P〈0. 001）. CONCLUSIONS Learning curve of esophagectomy is closely related to the occurrence rates of postoperative fistula. Postoperative fistula rates are higher in the beginning and declined after the completion of the learning curve. In order to reduce the incidence of postoperative fistula, we should be step hy step, summarizing the experience and improving surgical skilIs.

关 键 词：食管肿瘤 食管切除术 学习曲线 瘘 

分 类 号：R735.1[医药卫生—肿瘤]