腹腔镜根治性膀胱切除加回肠输出道标准化手术流程对术者学习曲线的影响  

Effects of standard surgical procedures on improvement of the learning curve of laparoscopic radical cystectomy and ileal conduit

作　　者：李凡[1] 张岩 刘征 胡嘏 宋文 宋晓东[1] LI Fan;ZHANG Yan;LIU Zheng;HU Jia;SONG Wen;SONG Xiaodong(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《现代泌尿生殖肿瘤杂志》2023年第1期21-24,36,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨标准化手术流程对腹腔镜根治性膀胱切除术(LRC)加回肠输出道手术术者学习曲线的影响。方法收集我院30例行LRC加回肠输出道手术患者的临床病理资料。按手术时间的先后顺序将所有患者分为A、B、C 3组,每组各10例。所有手术均由同一位主刀医生完成。在开始实施首例手术前,主刀医生对已制定的LRC加回肠输出道手术标准化流程进行学习,通过考核后即可开始独立进行手术。对比3组患者在手术时间、术中出血量、淋巴结清扫数量和术后并发症等方面的差异。结果所有患者均顺利完成手术,无中转开放或改变手术方式等情况。30例患者的平均手术时间为(388±96)min,术中平均出血量(443±206)ml,淋巴结清扫数量平均为(16±6)个。随着术者手术例数的不断增多,3组患者的手术时间相比逐渐缩短,术中出血量逐渐减少,术中淋巴结清扫数量则逐渐增多。上述指标的变化趋势与手术例数的增多呈线性相关。结论术者在独立完成A组的10例手术后,已能掌握LRC加回肠输出道手术的操作要点并独立完成手术。在完成B组的10例手术后,已熟练掌握该手术方式。在完成30例手术后术者的手术技术达到稳定状态。这说明通过建立标准化手术流程,能有效帮助术者缩短手术时间、减少术中出血量、降低患者术中和术后并发症的发生率,显著缩短了术者的学习曲线。Objective To study the value of establishing a standard surgical procedure to improve the learning curve of laparoscopic radical cystectomy(LRC)and ileal conduit(IC).Methods The clinicopathological data of 30 patients who underwent LRC and IC were collected and analyzed.Patients were divided into three groups,Group A,B and C,with 10 patients in each group.All procedures were completed by a single surgeon.Before the first operation,the surgeon systematically studied the standardized procedure.The differences in operation time,intraoperative estimated blood loss(EBL),number of lymph node dissections and postoperative complications among the three groups were compared.Results All the patients successfully underwent the operation without conversion to open radical cystectomy.The average operative time was(388±96)min.The intraoperative EBL was(443±206)ml.The number of lymph nodes dissection was(16±6).With the increasing number of surgical cases,the operative time in groups A,B and C gradually decreased(493±43)min,(390±41)min and(280±40)min,respectively;the EBL decreased(660±145)ml,(435±95)ml and(235±81)ml,respectively,and the number of lymph node dissection increased(11±3),(16±3)and(22±4),respectively.Conclusions By conducting the standard surgical procedures,junior surgeon can manipulate the LRC and IC.After completing 10 cases independently,the surgeon has mastered the key skills of LRC and IC.After completing 20 cases,the surgeon can manage the procedure skillfully.The learning curve shows a significant decline after 30 cases,and it can help to save the operation time,reduce the intraoperative EBL,and decrease the incidence of intraoperative and postoperative complications.

关 键 词：膀胱肿瘤 根治性膀胱切除 回肠输出道腹腔镜手术 学习曲线 

分 类 号：R737.14[医药卫生—肿瘤]