腹腔镜直肠癌经肛全直肠系膜切除术学习曲线的多中心研究  

A multicenter study on learning curve of laparoscopic transanal total mesorectal excision for rectal cancer

作　　者：李梦 任明扬[2] 徐庆[3] 陈建志 张宏宇[5] 肖毅[6] 傅志聪 张庆彤[8] 姚宏伟[9] 王权[1] 张忠涛[9] Li Meng;Ren Mingyang;Xu Qing;Chen Jianzhi;Zhang Hongyu;Xiao Yi;Fu Zhicong;Zhang Qingtong;Yao Hongwei;Wang Quan;Zhang Zhongtao(Department of Gastric and Colorectal Surgery,the First Affiliated Hospital of Jilin University,Changchun 130021,China;Department of Gastrointestinal Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China;Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of General Surgery,Koo Foundation Sun Yat‐Sen Cancer Center,Taipei 112019,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Department of General Surgery,Peking Union Medical College Hospital,Beijing 100730,China;Department of General Surgery,Queen Mary Hospital,University of Hong Kong,Hongkong 9077,China;Department of Colorectal Surgery,Liaoning Cancer Hospital,Shenyang 110042,China;Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]吉林大学第一医院胃结直肠外科,长春130021 [2]川北医学院附属南充市医学中心医院胃肠外科,637000 [3]上海交通大学医学院附属仁济医院胃肠外科,200127 [4]中国台北和信治癌医学中心医院外科,112019 [5]重庆医科大学附属第一医院胃肠外科,400042 [6]北京协和医院基本外科,100730 [7]香港大学玛丽医院外科,9077 [8]辽宁省肿瘤医院结直肠外科,沈阳110042 [9]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床医学研究医学中心,100050

出　　处：《中华消化外科杂志》2021年第3期306-314,共9页Chinese Journal of Digestive Surgery

基　　金：国家卫生计生委行业重点专项(W2017ZWS01)。

摘　　要：目的探讨一个手术团队及两个手术团队施行腹腔镜直肠癌经肛全直肠系膜切除术(taTME)的学习曲线。方法采用回顾性横断面研究方法。基于“真实世界研究”理念,收集2010年5月至2020年5月中国taTME病例登记协作研究数据库中44家医学中心1458例腹腔镜直肠癌taTME数据,根据手术方式分为一个手术团队和两个手术团队分别收集资料。一个手术团队先行经腹后经肛的手术操作。两个手术团队同时进行经肛经腹的手术操作(同时操作持续时间≥30 min),但不要求整个手术过程均为两个团队。选择手术量相近的医学中心,按照手术时间顺序收集病例资料,分析不同手术开展阶段的临床资料,探讨学习曲线。以手术时间为参数进行累积和分析,绘制各医学中心开展腹腔镜直肠癌taTME的学习曲线。选择学习曲线差异最大的两家医学中心比较病人的临床病理特征。观察指标:(1)病例资料筛选结果。(2)一个手术团队病例资料收集情况。(3)一个手术团队不同手术开展阶段腹腔镜直肠癌taTME情况。(4)一个手术团队学习曲线情况。(5)两个手术团队病例资料收集情况。(6)两个手术团队不同手术开展阶段腹腔镜直肠癌taTME情况。(7)两个手术团队学习曲线情况。累积和通过CUSUM=∑i=1n(Xi-U),进行计算,其中Xi表示每例taTME的手术时间,U表示所有病例手术时间的平均值,n表示手术序号。对学习曲线散点图进行拟合,以拟合曲线的顶点作为分界,将学习曲线划分为两个阶段。学习曲线顶点所对应的横坐标为跨越学习曲线所需要进行的手术例数。正态分布的计量资料以x±s表示,两组比较采用t检验,多组比较采用方差分析;偏态分布的计量资料以M(P25,P75)表示,组间比较采用Mann-Whitney U检验;等级资料比较采用秩和检验;计数资料采用χ^(2)检验或Fisher确切概率法。结果(1)病例资料筛选结果:一个手术团队和Objective To investigate the learning curve of laparoscopic transanal total mesorectal excision(taTME)for rectal cancer operated by one or two surgery teams.Methods T retrospective cross‐sectional study was conducted.Based on the concept of real-world research,the clinical data of 1458 patients undergoing laparoscopic rectal cancer taTME from 44 medical centers who were registered in the Chinese taTME registry collaborative(CTRC)database from May 2010 to May 2020 were collected.The 1458 patients were divided into cohorts with one surgery team or two surgery teams according to the operation method.Patients with one surgery team underwent taTME by transabdominal operation and then by transanal operation.Patients with two surgery teams underwent taTME by transabdominal and transanal operation simultaneously with duration of the simutaneous operation time≥30 minutes.The entire surgical process of patients with two were collected from the medical centers with similar operation amount according to the operation time sequence to analyze the difference between different operation stages and explore the learning curve.The operation time was taken as the parameter to carry out cumulative sum analysis and draw the learning curve of laparoscopic rectal cancer taTME in each medical center.The clinicopathological characteristics of patients from two medical centers with the largest difference in learning curves were analyzed.Observation indicators:(1)screening results of clinical data;(2)clinical data collection of patients with one surgery team;(3)surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages;(4)learning curve of the one surgery team;(5)clinical data collection of patients with two surgery teams;(6)surgical situations of laparoscopic rectal cancer taTME from the two surgery teams;(7)learning curve of the two surgery teams.The cumulative sum was calculated by the CUSUM=∑i=1n(Xi-U),where Xi represented the operation time of each taTME,U represented the aver

关 键 词：直肠肿瘤 经肛全直肠系膜切除术 中国经肛全直肠系膜切除病例登记协作研究 学习曲线 腹腔镜检查 

分 类 号：R735.37[医药卫生—肿瘤]