腹股沟斜疝患者行腹腔镜经腹腹膜外修补术学习曲线分析  

Analysis of learning curve of laparoscopic extraperitoneal repair in patients with indirect inguinal hernia

作　　者：李伟[1] 孔维杰 邢冰琛 李莲华[1] 刘彤[1] 文武[1] 伍冀湘 李志霞[1] LI Wei;KONG Wei-jie;XING Bing-chen(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院普外科,北京100730

出　　处：《临床和实验医学杂志》2021年第12期1279-1282,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金(编号:81601519);北京市医管局临床医学发展专项(扬帆计划)重点医学专业发展计划项目(编号:ZYLX201612)。

摘　　要：目的探讨高年资主治外科医师对原发性腹股沟斜疝行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2018年6月至2021年2月首都医科大学附属北京同仁医院同一名医师连续进行TAPP手术的55例(64例次)腹股沟斜疝患者的临床资料。按手术日期先后顺序详细记录每例患者的手术时间,使用累积和法得到学习曲线;再通过分析比较学习曲线完成前后患者总手术时间、各分步手术时间、术后住院时间等指标验证学习曲线结果,并寻找影响学习曲线的相关因素。结果总手术时间的学习曲线在20例次处达到最高点,20~40例次为平台期。度过学习曲线后组总手术、游离腹膜间隙、放置补片、缝合腹膜时间及术后住院时间分别为(64.80±18.53)min、(5.05±1.43)min、(5.52±1.77)min、(9.77±2.35)min、(1.45±0.50)d,均短于度过学习曲线前组[(134.45±30.97)min、(14.20±6.93)min、(12.2±5.42)min、(31.15±13.20)min、(1.90±0.55)d],差异均有统计学意义(P<0.05);而游离疝囊时间[(32.45±16.98)min vs.(64.90±11.95)min]比较,差异无统计学意义(P>0.05)。以40例为界点,度过学习曲线后组的手术时间为(22.79±8.04)min,较度过学习曲线前组(54.48±18.29)min显著缩短,差异有统计学意义(P<0.05)。结论有一定腹腔镜经验的高年资主治医师对腹股沟斜疝患者行TAPP的学习曲线为20例次左右,其后有20例次左右的平台期,主要与游离疝囊这一手术步骤有关。Objective To investigate the learning curve of senior attending surgeons in the treatment of primary indirect inguinal hernia by laparoscopic transperitoneal preperitoneal hernia repair(TAPP).Methods Clinical data of 55(64 number of cases)patients with indirect inguinal hernia who underwent TAPP operation by the same physician in Beijing Tongren Hospital,Capital Medical University from June 2018 to February 2021 were retrospectively analyzed.The operation duration of each patient was recorded,and the learning curve was obtained by the cumulative sum method.The results of the learning curve were verified by analyzing and comparing the total operative time before and after the completion of the learning curve.The learning curve of each step of operation,the length of postoperative hospital stay and the related factors affecting the learning curve were also analyzed.Results The learning curve of the total operation time reached the highest point in 20 number of cases,and the plateau period was 20-40 number of cases.The total operation time,free peritoneal space,patch placement,peritoneal suture and postoperative hospital stay were(64.80±18.53)min,(5.05±1.43)min,(5.52±1.77)min,(9.77±2.35)min,(1.45±0.50)d in after passing the learning curve group,which were shorter than those in before passing the learning curve group[(134.45±30.97)min,(14.20±6.93)min,(12.2±5.42)min,(31.15±13.20)min,(1.90±0.55)d],the differences were statistically significant(P<0.05);while the free hernia sac time[(32.45±16.98)min vs.(64.90±11.95)min],the difference was not statistically significant(P>0.05).Taking 40 cases as the cut-off point,the operation time of the group after passing the learning curve was(22.79±8.04)min,which was significantly shorter than that of the group before passing the learning curve(54.48±18.29)min,and the difference was statistically significant(P<0.05).Conclusion The learning curve of TAPP for patients with indirect inguinal hernia performed by senior attending physicians is about 20 number of cases,follo

关 键 词：腹股沟疝 疝修补术 经腹腹膜前修补术 学习曲线 累积和法 

分 类 号：R656.21[医药卫生—外科学]