掌握腹腔镜胃切除手术对于缩短腹腔镜胰腺手术学习曲线的正面作用  

Positive impact of mastering laparoscopic gastrectomy on shortening the learning curve of laparoscopic pancreaticoduodenectomy

作　　者：王骥 马红钦 刘利 杜羽升 赵文星 Wang Ji;Ma Hongqin;Liu Li;Du Yusheng;Zhao Wenxing(Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院普通外科,江苏徐州221002

出　　处：《中华肝胆外科杂志》2020年第8期577-580,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析术者熟练掌握腹腔镜胃切除手术是否有助于更快掌握腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)。方法回顾性分析自2015年1月至2016年10月徐州医科大学附属医院普通外科同一团队在熟练掌握腹腔镜胃切除手术的基础上,序贯实施LPD的41例患者临床及围手术期资料,LPD的学习曲线通过累积和分析法(CUSUMOT)和风险调整后累积和分析法(RA-CUSUM)进行分析。结果41例患者中男25例,女16例,年龄25.0~83.0(60.6±13.7)岁,患者均顺利完成LPD,手术时间(456.3±85.9)min。术后生化瘘4例(9.8%),B级胰瘘4例(9.8%),无C级胰瘘。术后Clavien-Dindo分级≥Ⅲ级的并发症10例(24.39%),死亡1例。CUSUMOT法提示在第33例患者之后度过学习曲线,RA-CUSUM法提示在第31例患者之后度过学习曲线,两者结果基本位于同一时间。结论术者熟练掌握腹腔镜胃切除手术,可以更快掌握LPD手术中的关键技术,更安全快速地度过LPD学习曲线。Objective To find out whether surgeon's proficiency in laparoscopic gastrectomy helps to get over the learning curve of laparoscopic pancreaticoduodenectomy(LPD)more quickly.Methods From January 2015 to October 2016,the clinical and perioperative data of 41 consecutive patients who underwent LPD at the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The learning curves were evaluated using the CUSUMOT method and RA-CUSUM method.Results Of 41 patients,25 were males and 16 were females,with age ranging from 25.0 to 83.0(60.6±13.7)years.These patients all successfully underwent LPD,with operation time Mean±SD being(456.3±85.9)min.There were 4 patients(9.8%)who developed biochemical fistula and 4 patients(9.8%)grade B pancreatic fistula.There was no grade C pancreatic fistula after operation.There were 10 patients who developed postoperative complications≥Clavien-Dindo grade Ⅲ(24.39%)and 1 died.The data of the CUSUMOT method showed the learning curve to be over after the 33rd patient and the data of the RA-CUSUM method showed the learning curve to be over after the 31st patient.Conclusions Laparoscopic gastrectomy helped surgeons to master the key techniques in LPD faster,and to get over the learning curve more safely and quickly.

关 键 词：胰十二指肠切除术 腹腔镜 学习曲线 

分 类 号：R657.5[医药卫生—外科学]