以累积和分析法研究保留耻骨后间隙机器人辅助根治性前列腺切除术的学习曲线  

Analysis of learning curve of retzius-sparing robot-assisted laparoscopic radical prostatectomy by cumulative summation analysis

作　　者：方昌华 杜霖 陈鑫楠 王昊 王文帝 张成伟 秦海翔 邱雪峰[1] 庄君龙[1] 徐林峰[1] 郭宏骞[1] 张古田[1] Changhua Fang;Lin Du;Xinnan Chen;Hao Wang;Wendi Wang;Chengwei Zhang;Haixiang Qin;Xuefeng Qiu;Junlong Zhuang;Linfeng Xu;Hongqian Guo;Gutian Zhang(Department of Urology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,210008

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第4期319-325,共7页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的通过应用累积和分析(CUSUM)法,探讨保留耻骨后间隙机器人辅助根治性前列腺切除术(RsRARP)的学习曲线,评估手术者的学习过程。方法回顾性分析2016年10月至2021年9月1日由单术者连续进行的161例RsRARP患者的临床资料。应用CUSUM法以手术时间作为衡量指标分析RsRARP学习曲线。根据CUSUM分析结果,确定手术学习曲线的拐点,利用学习曲线变化的拐点划分学习阶段,比较学习曲线各阶段的术中失血量、手术时间、并发症、切缘阳性率和术后尿控等指标。并采用Kaplan-Meier曲线计算术后尿控情况。结果161例患者手术均顺利完成,无中转开放。根据CUSUM分析,学习曲线可分为三个阶段:早期学习37例,技能提高71例,熟练掌握53例。随着手术例数的增加,手术时间明显缩短(P<0.001),术中出血明显减少(P<0.001),术后住院时间明显缩短(P<0.001)。熟练掌握阶段中位手术时间为185 min,术后即刻尿控率为64.2%,pT_(2)期患者切缘阳性率为11.3%,pT_(2)期患者的1年无生化复发率为96.7%。三个阶段的即刻尿控率、并发症发生率、切缘阳性率、生化复发率差异无统计学意义。结论通过应用CUSUM分析方法,对RsRARP的学习曲线进行了量化评估,为该手术的培训和推广提供了重要参考。Objective To explore the learning curve of Retzius-sparing robot-assisted radical prostatectomy (RsRARP) using cumulative sum (CUSUM) method and evaluate the learning process of the surgeon.MethodsA retrospective analysis of clinical data of 161 consecutive RsRARP patients performed by a single surgeon between October 2016 and September 2021 was conducted. CUSUM analysis was used to analyze the learning curve of RsRARP using surgical time as a measure. The inflection point of the learning curve was determined based on the CUSUM analysis results, and the learning stages were divided according to the inflection point of the learning curve. The intraoperative blood loss, surgical time, complications, positive surgical margin rates, and postoperative urinary control were compared among the learning stages. Kaplan-Meier curve was used to calculate the postoperative continence.ResultsAll 161 cases were completed surgeries successfully without any conversion to open. According to the CUSUM analysis, the learning curve can be divided into three stages: early learning stage with 37 cases, skill improvement stage with 71 cases, and proficiency stage with 53 cases. As the number of surgeries increased, surgical time significantly decreased (P<0.001), intraoperative blood loss significantly decreased (P<0.001), and postoperative hospital stay significantly shortened (P<0.001). The median surgical time in the proficiency stage was 185 min, immediate urinary continence rate was 64.2%, positive surgical margin rate for pT_(2) patients was 11.3%, and the 1-year biochemical recurrence-free rate for pT_(2) patients was 96.7%. The immediate urinary continence rate, complication rate, positive surgical margin rate, and biochemical recurrence rate showed no significant difference among the three stages.ConclusionsBy CUSUM analysis, the learning curve of RsRARP can be evaluated quantitatively, that provides important reference for the training and promotion of RsRARP surgery.

关 键 词：耻骨后间隙 机器人辅助 腹腔镜 前列腺切除术 学习曲线 累积和分析法 

分 类 号：R737.25[医药卫生—肿瘤]