经培训的手术者学习曲线对早期宫颈癌腹腔镜根治术并发症的影响  

The influence of trained surgeons′learning curve on the complications of laparoscopic radical surgery for early cervical cancer

作　　者：高玮睿 杨萍[1] Gao Weirui;Yang Ping(Department of Gynaecology,the First Affiliated Hospital,School of Medicine,Shihezi University,National Health Commission Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases,Shihezi 832008,China)

机构地区：[1]石河子大学医学院第一附属医院妇科,国家卫生健康委中亚高发病防治重点实验室,石河子832008

出　　处：《中国医师杂志》2022年第8期1125-1130,共6页Journal of Chinese Physician

基　　金：国家自然科学基金(82072893);石河子大学成果转化与技术推广计划项目(CGZH201701);中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(2020-PT330-003)。

摘　　要：目的研究经微创手术培训的手术者学习曲线对早期宫颈癌腹腔镜根治术并发症的影响。方法回顾性纳入72例连续手术病例,按主刀医师的学习曲线和先后顺序分为两个学习阶段(第一阶段、第二阶段),比较两阶段组患者的临床病理特征和手术并发症。结果第二阶段组患者的既往腹部手术史比例更高(55.6%vs 31.1%,P=0.041),临床分期为局部晚期的患者比例也较高(29.6%vs 6.7%,P=0.022)。两阶段组患者的病理特征比较,差异均无统计学意义(均P>0.05)。所有72例腹腔镜根治手术共发生严重手术损伤4例(第一阶段组3例,第二阶段组1例),术后并发症36例(第一阶段组20例,第二阶段组16例),两阶段组严重手术损伤和手术并发症发生率比较差异无统计学意义(P=1.000,0.224)。多因素logistic回归分析结果显示,患者年龄>51岁是早期宫颈癌腹腔镜根治术手术并发症的独立危险因素(HR=3.404,95%CI:1.132~10.234,P=0.029)。结论经培训的手术者行宫颈癌腹腔镜根治术手术并发症发生率低,手术学习曲线对并发症的影响较小,但不能排除其对严重手术损伤的影响。Objective To study the effect of minimally invasive surgery training on the complications of laparoscopic radical surgery for early cervical cancer.Methods 72 cases of continuous surgery were retrospectively included.According to the learning curve and order of the chief surgeon,they were divided into two learning stages(the first stage and the second stage).The clinicopathological characteristics and surgical complications of the two stage group were compared.Results The proportion of patients with previous abdominal surgery in the second stage group was higher(55.6%vs 31.1%,P=0.041),and the proportion of patients with local advanced clinical stage was also higher(29.6%vs 6.7%,P=0.022).There was no significant difference in the pathological characteristics between the two groups(all P>0.05).In all 72 cases of laparoscopic radical surgery,there were 4 cases of serious surgical injury(3 cases in the first stage group and 1 case in the second stage group),and 36 cases of postoperative complications(20 cases in the first stage group and 16 cases in the second stage group).There was no significant difference in the incidence of serious surgical injury and surgical complications between the two stage groups(P=1.000,0.224).Multivariate logistic regression analysis showed that age>51 years old was an independent risk factor for surgical complications after laparoscopic radical resection of early cervical cancer(HR=3.404,95%CI:1.132-10.234,P=0.029).Conclusions The incidence of complications in laparoscopic radical hysterectomy of cervical cancer for trained operators is low,and the impact of surgical learning curve on complications is small,but its impact on serious surgical injury cannot be ruled out.

关 键 词：宫颈肿瘤 子宫切除术 腹腔镜检查 手术并发症 学习曲线 

分 类 号：R737.33[医药卫生—肿瘤]