Rul-tractor装置辅助经剑突下胸腔镜胸腺肿瘤切除术学习曲线分析  

An analysis on learning curve of subxiphoid thoracoscopic thymic tumor resection assisted by the Rul-tractor device

作　　者：鲍峰[1] 车云 元及 吴宗阳[1] Bao Feng;Che Yun;Yuan Ji;Wu Zongyang(Department of Thoracic Surgery,Anhui Provincial Armed Police Corps Hospital,Hefei Anhui 230001,China;National Cancer Center,Cancer Hospital of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]武警安徽省总队医院胸外科,安徽合肥230000 [2]国家癌症中心,中国医学科学院北京协和医学院肿瘤医院,北京100021

出　　处：《遵义医科大学学报》2022年第2期200-205,共6页Journal of Zunyi Medical University

基　　金：中国癌症基金会北京马拉松专项基金资助项目(NO:LC2019B18)。

摘　　要：目的评估在Rul-tractor装置辅助下,经剑突下胸腔镜胸腺肿瘤切除术的手术效果和学习曲线。方法纳入2019年1月至2020年5月武警安徽省总队医院胸外科29名前纵隔肿瘤患者,由年轻外科医生独立完成Rul-tractor装置辅助下剑突下胸腔镜胸腺肿瘤切除手术。总结临床特点和手术结果,并以手术时间的累积和(CUSUM)值评价学习曲线。结果所有患者均接受全胸腺切除术,包括肿瘤R0切除,无中转至正中胸骨切开。如合并重症肌无力(Myasthenia gravis,MG)则需行前纵隔脂肪扩大清扫术,合并MG的患者有4例(13.8%);临床特点中肿瘤直径为2.6~7.0 cm,平均直径4.3±1.8 cm;位置较高骑跨于无名静脉的肿瘤18例(62.1%);术后组织学病理特征中胸腺瘤17例(59.0%)、胸腺囊肿9例(31.1%)、胸腺癌1例(3.3%)、胸腺增生1例(3.3%)、畸胎瘤1例(3.3%);手术时间70~150 min,平均时间(103.0±19.8)min,术中出血量15~100 mL,平均为(31.5±15.8)mL,带管时间1~5 d,平均(2.9±2.2)d,住院天数3~9 d,平均(5.4±2.1)d;术中术后并发症4例(13.8%),无肌无力危象发生;无术后死亡及复发病例。手术时间在19例后趋于下降平稳趋势。结论在Rul-tractor胸骨牵拉装置的辅助下实施剑突下胸腔镜胸腺肿瘤切除术,学习曲线约为19例,可被无丰富手术经验的年轻外科医生快速掌握,获得的手术结果可以接受。Objective To evaluate the outcome and learning curve of subxiphoid thoracoscopic thymectomy assisted by the Rul-tractor device.Methods From January 2019 to May 2020,29 patients with anterior mediastinal tumors were recruited at the Department of Thoracic Surgery,Anhui Provincial Armed Police Corps Hospital and Rul-tractor device-assisted subxiphoid thoracoscopic thymic tumor resection was independently conducted by young surgeon.The clinical features and surgical outcomes were summarized and the learning curve with the accumulated sum of surgical time and the(CUSUM)value were evaluated.Results All patients received total thymectomy,including R0 resection of the tumor,with no mid-turn to median sternotomy.In the case of combined myasthenia gravis(MG),an extended anterior mediastinal fat clearance was required.4 patients(13.8%)had combined MG;The tumor diameter was(2.6-7.0)cm,with an mean diameter of(4.3±1.8)cm;18 cases(62.1%)had tumors with high location riding across the innominate vein;Of the postoperative histopathological features 17 cases(59.0%)of thymoma,9 cases(33.1%)of thymic,1 case(3.3%)of cystthymic carcinoma,1 case(3.3%)of thymic hyperplasia,and 1 case(3.3%)of teratoma.The operation time was(70-150)min,and the mean time was(103.0±19.8)min,Intraoperative bleeding was(15-100)ml,with mean(31.5±15.8)ml,Time with the tube was(1-5)days,with mean(2.9±2.2)days,hospitalization days(3-9)days,with mean(5.4±2.1)days;Moreover,intraoperative and postoperative complications were 4 cases(13.8%),and no myasthenic crisis occurred;No cases of postoperative death or recurrence.The duration of surgery tended to decrease and stabilize after 19 cases.Conclusion The learning curve of subxiphoid thoracoscopic thymic tumor resection assisted by the Rul-tractor sternal traction device is approximately 19 cases,which can be quickly mastered by young surgeons without extensive surgical experience,and the results are acceptable.

关 键 词：Rul-tractor装置 胸腺肿瘤 剑突下 手术结果 学习曲线 

分 类 号：R655.5[医药卫生—外科学]