机器人辅助微创食管癌切除术的学习曲线  

Learning curve of robot⁃assisted minimally invasive esophagectomy

作　　者：程尼涛 蒋鹏飞 王现国[1] 黄静宇[1] 刘俊[1] 胡卫东[1,2] CHENG Nitao;JIANG Pengfei;WANG Xianguo;HUANG Jingyu;LIU Jun;HU Weidong(Dept.of Thoracic Cardiovascular Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Hubei Provincial Cancer Clinical Research Center&Hubei Key Laboratory of Biological Behavior of Tumor,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院胸外科,湖北武汉430071 [2]肿瘤生物学行为湖北省重点实验室/湖北省肿瘤医学临床研究中心,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2024年第2期127-131,137,共6页Medical Journal of Wuhan University

基　　金：武汉大学中南医院科技创新培育基金(LCYF202208);武汉大学中南医院转化医学与交叉学科研究联合基金(ZNJC202015)。

摘　　要：目的:探讨机器人辅助微创食管癌切除术(RAMIE)的学习曲线。方法:回顾性分析2019年11月—2022年12月由同一术者完成的35例RAMIE患者的临床资料。使用累积和(CUSUM)方法分析学习曲线,并对不同阶段的总手术时长、术中出血量、术后引流量、术后住院时间、手术并发症发生率等指标进行比较。结果:成功构建CUSUM学习曲线的最佳拟合方程,拟合优度系数在R^(2)=0.930达到最大值(P<0.001)。CUSUM曲线在手术例数达16例时达峰值,并以此为界将学习曲线划分为两个阶段:初期学习阶段(A阶段)和熟练阶段(B阶段)。B阶段总手术时长、术中出血量、术后24 h引流量、术后胸腔引流管留置时间、术后住院时间、术后转重症监护室例数均明显优于A阶段(P<0.05)。但A、B两阶段的手术并发症发生率比较,差异无统计学意义(P=0.127)。结论:实施RAMIE的医生,在手术例数累计达到16例时,手术可达到满意效果。Objective:To evaluate the learning curve of robot‐assisted minimally invasive esophagectomy(RAMIE).Methods:The clinical data of 35 patients with esophageal cancer who underwent RAMIE by the same surgical team from November 2019 to December 2022 was retrospectively analyzed.The cumulative sum(CUSUM)approach was employed to study the learning curve of RAMIE.Operating time,blood loss,number of dissected lymph nodes,postoperative hospital stay,and incidence rate of postoperative complications were analyzed.Results:The CUSUM learning curve was successfully constructed,and the best‐fit equation was obtained.The coefficient of determination(R^(2))was 0.930(P<0.001),indicating a good fit.The curve showed a vertex crossing when the number of cases reached 16.Based on this,35 patients were divided into a learning and improving stage and a mas‐tering stage.The operating time,blood loss,postoperative drainage volume,postoperative catheter time,postoperative hospital stay,and number of patients transferred to the ICU postoperatively in stage B were significantly better than those in stage A(P<0.05).In contrast,there was no significant difference in the incidence of surgical complications between stage A and stage B(P=0.127).Con⁃clusion:It is demonstrated that physicians who perform RAMIE can attain satisfactory outcomes when they have conducted a cumulative total of 16 surgical cases.

关 键 词：机器人辅助微创食管癌切除术 食管癌 累积和分析 学习曲线 

分 类 号：R735.1[医药卫生—肿瘤]