达芬奇机器人辅助直肠及乙状结肠癌根治术的学习曲线分析  

Analysis of the learning curve of Da Vinci robotic-assisted radical surgery for rectal and sigmoid colon cancer

作　　者：陈海鹏 张金珠 关旭 赵志勋 刘恒昌 姜争 刘正 王锡山 Chen Haipeng;Zhang Jinzhu;Guan Xu;Zhao Zhixun;Liu Hengchang;Jiang Zheng;Liu Zheng;Wang Xishan(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021

出　　处：《中华结直肠疾病电子杂志》2024年第3期205-208,共4页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：中国医学科学院肿瘤医院住培教学课题(E2021008)。

摘　　要：目的分析达芬奇机器人辅助直肠及乙状结肠癌根治术的学习曲线,探索最佳的学习例数.方法回顾性分析2021年7月至2022年12月于中国医学科学院肿瘤医院由同一术者完成的93例达芬奇机器人辅助直肠及乙状结肠癌根治术的临床资料.根据手术时间构建达芬奇机器人辅助直肠及乙状结肠癌根治术的学习曲线,根据曲线峰值确定最佳学习例数,并按照学习曲线将患者分为手术提高组(A组)及手术熟练组(B组),对比两组临床指标.结果93例患者顺利实施达芬奇机器人辅助乙状结肠或直肠癌根治术,最佳拟合曲线方程为:根据CUSUM值进行曲线拟合,曲线方程为y=0.006x3-1.183x2+58.840x-219.293,R2=0.857,P<0.01.达到学习曲线最佳手术例数为33例.将前33例患者列为A组,将之后的60例患者列为B组.与A组相比,B组的手术所需时间更短(144.3 min vs.179.1 min,P=0.008),失血量更少(21.7 mL vs.29.4 mL,P=0.010),术后住院时间更短(7.1 d vs.8.8 d,P=0.026)o结论达芬奇机器人手术需要一定的学习例数.本研究表明33例为最佳学习例数.完成33例达芬奇机器人手术学习后,患者手术时间更短,失血量更少,术后住院时间更短.Objective To analyze the learning curve of Da Vinci robotic-assisted radical surgery for rectal and sigmoid colon cancer and explore the optimal number of learning cases.Methods A retrospective analysis was conducted on the clinical data of 93 cases of Da Vinci robotic-assisted radical surgery for rectal and sigmoid colon cancer performed by the same surgeon at the Cancer Hospital,Chinese Academy of Medical Sciences from July 2021 to December 2022.The learning curve of Da Vinci robotic-assisted radical surgery for rectal and sigmoid colon cancer was constructed based on the surgical time.The optimal number of learning cases was determined according to the peak of the curve,and patients were divided into the surgery improvement group(Group A)and the surgery proficiency group(Group B)according to the learning curve for comparison of clinical parameters.Results Ninety-three patients successfully underwent Da Vinci robotic-assisted radical surgery for sigmoid colon or rectal cancer.The best fitting curve equation was:curve fitting according to CUSUM values,the curve equation was y=0.006x3-1.183x2+58.840x-219.293,R2=0.857,P<0.01.The optimal number of surgeries to reach the learning curve was 33 cases.The first 33 patients were classified as the A group,and the subsequent 60 patients were classified as the B group.Compared with the Group A,the Group B had shorter operative time(144.3 min vs.179.1 min,P=0.008),less blood loss(21.7 mL vs.29.4 mL,P=0.010),and shorter postoperative hospital stay(7.1 d vs.8.8 d,P=0.026).Conclusion Da Vinci robotic surgery requires a certain number of learning cases.This study suggests that 33 cases are the optimal number of learning cases.After completing 33 cases of Da Vinci robotic surgery learning,patients had shorter operative time,less blood loss,and shorter postoperative hospital stay.

关 键 词：结直肠肿瘤 达芬奇机器人辅助手术 学习曲线 

分 类 号：R735.37[医药卫生—肿瘤]