以CUSUM法分析手辅助腹腔镜结直肠癌根治术的学习曲线  

The learning curve of hand-assisted laparoscopic radical resection for colorectal cancer by cumulative sum analysis

作　　者：任镜清 刘少杰 罗辉兴 王百林 吴帆 REN Jingqing;LIU Shaojie;LUO Huixing;WANG Bailin;WU Fan(Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510060, China)

机构地区：[1]暨南大学附属广州红十字会医院普外科,广东广州510220

出　　处：《暨南大学学报（自然科学与医学版）》2020年第3期235-240,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省医学科学技术研究基金项目(A2018028)。

摘　　要：目的:通过回顾分析连续患者的手术时间,术中出血量等数据,探讨同一组术者行手辅助腹腔镜结直肠癌根治术的学习曲线.方法:对同一组术者连续开展的154例手辅助腹腔镜结直肠癌根治术患者进行分析,对于每一例患者的手术时间,采用累积和分析法(CUSUM)、风险调整累积和分析法(RA-CUSUM)绘制手辅助腹腔镜结直肠癌根治术的学习曲线,比较学习曲线不同阶段的手术时间、术中出血量、淋巴结检出数目、中转开腹率、术后住院时间、总住院费用和术后并发症发生率的差异.结果:CUSUM法得出曲线最大转折点在32例处,以此为分界将学习曲线划分为学习提高、熟练掌握两个阶段,两个阶段患者的一般资料、病理资料比较其差异无统计学意义(P>0.05),术者熟练掌握阶段患者的手术时间、术中出血量、淋巴结检出数目、中转开腹率、术后住院时间、总住院费用、术后并发症发生率均优于学习提高阶段(均P<0.05).结论:通过CUSUM分析法对手辅助腹腔镜结直肠癌根治术的学习曲线进行精准剖析,表明术者驾驭该技术须累积的手术例数为32例.Objective:Explore the learning curve of hand-assisted laparoscopic radical resection of colorectal cancer by retrospectively analyzing the data of surgical time and intraoperative blood loss in consecutive patients,Methods:Patients(n=154)with hand-assisted laparoscopic radical colorectal cancer were recruited in the study.The cumulative sum analysis(CUSUM)and risk-adjusted cumulative sum analysis(RA-CUSUM)were used to determine the learning curve of hand-assisted laparoscopic radical resection for colorectal cancer for each patient's operation time By analyzing The operation time,blood loss,number of lymph node,rate of conversion,postoperative hospital stay,total hospitalization cost and postoperative complication rate were compared between the different stage of the learning curve.Results:The CUSUM method obtained the maximum turning point of the curve at 32 cases,which divided the learning curve into two stages:learning improvement and mastery.However,The general data and pathological data of the two stages were not statistically significant(P>0.05).The operation time of the two groups were(231.25±32.33)min and(184.11±27.84)min,the blood loss were(97.19±79.36)mL and(50.98±22.10)mL,the number of lymph node were(17.09±6.87)and(20.73±6.77),the rate of conversion were 3/32 and 1/122,the postoperative hospital stay were(12.44±3.27)d and(10.65±3.42)d,the total hospitalization cost were(87465.66±14293.80)yuan and(81527.32±10991.46)yuan,and the postoperative complication rate were 8/32 and 3/122.Statistically significant difference was detected in the operation time,blood loss,number of lymph node,rate of conversion,postoperative hospital stay,total hospitalization cost and postoperative complication rate in the two stages(P<0.05).Conclusion:Accurate analysis of the learning curve of hand-assisted laparoscopic radical resection for colorectal cancer by CUSUM showed that the required number of surgical procedures to the technique was 32.

关 键 词：手辅助腹腔镜 结直肠癌 学习曲线 

分 类 号：R735.3[医药卫生—肿瘤]