经剑突下机器人辅助全胸腺切除术学习曲线及临床分析  

Clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach

作　　者：汪涛 鄂浩然 吴峻 杨晨路[1] 姜格宁[1] 朱余明[1] 陈昶[1] 赵德平[1] WANG Tao;E Haoran;WU Jun;YANG Chenlu;JIANG Gening;ZHU Yuming;CHEN Chang;ZHAO Deping(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,School of Medicine,Tongji University,Shanghai,200082,P.R.China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200082

出　　处：《中国胸心血管外科临床杂志》2023年第6期830-834,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市卫生健康委员会科研课题(202040322)。

摘　　要：目的探讨经剑突下机器人辅助全胸腺切除术学习曲线及临床疗效。方法回顾性分析2021年2月—2022年8月上海市肺科医院胸外科同一手术团队连续开展的经剑突下机器人辅助胸腺切除术患者的临床资料。采用累积和(cumulative sum,CUSUM)分析法及最佳拟合曲线分析该手术的学习曲线,对比不同学习阶段患者一般资料及围术期指标,探究不同学习阶段对患者临床疗效的影响。结果共67例患者纳入研究,其中男31例、女36例,年龄57.10(54.60,59.60)岁。手术时间为117.00(87.00,150.00)min;CUSUM学习曲线的最佳拟合方程为y=0.0212x^(3)–3.1925x^(2)+120.17x–84.444(x为手术例数),模型拟合优度R^(2)=0.9778;CUSUM曲线在第25例达到顶点,以此为界将学习曲线划分为学习期和熟练期;熟练期患者手术时间和术中出血量较学习期患者显著缩短或减少(P<0.001)。胸腔引流管放置时间及胸腔引流量两阶段差异无统计学意义(P>0.05)。结论经剑突下机器人辅助胸腺切除术学习过程安全,经过25例手术后可熟练掌握此技术。Objective To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach.Methods The clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team from the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed.The cumulative sum(CUSUM)analysis and best fit curve were used to analyze the learning curve of this surgery.The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients.Results A total of 67 patients were enrolled,including 31 males and 36 females,aged 57.10(54.60,59.60)years.The operation time was 117.00(87.00,150.00)min.The best fitting equation of CUSUM learning curve was y=0.0212x^(3)–3.1925x^(2)+120.17x–84.444(x was the number of surgical cases),which had a high R^(2)value of 0.9778,and the fitting curve reached the top at the 25th case.Based on this,the learning curve was divided into a learning period and a proficiency period.The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those of the learning stage(P<0.001),and there was no statistical difference in thoracic drainage time,thoracic drainage volume between the two stages(P>0.05).Conclusion The learning process of robot-assisted thymectomy via subxiphoid approach is safe,and this technique can be skillfully mastered after 25 cases.

关 键 词：经剑突下 机器人辅助手术 胸腺切除术 累积和分析法 学习曲线 

分 类 号：R736.3[医药卫生—肿瘤]