老年患者3D单孔胸腔镜单向式解剖性右肺上叶切除术的学习曲线  

Learning curve of single-direction anatomical right upper lobectomy by 3D uniportal video-assisted thoracoscopy in elderly patients

作　　者：茅怡铭 陆文强 戴春雷 Mao Yiming;Lu Wenqiang;Dai Chunlei(Department 2 of Thoracic Surgery,Suzhou Kowloon Hospital,Shanghai Jiaotong University School of Medicine,Suzhou,Jiangsu,215028,P.R.China;Department of Thoracic Surgery,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,215000,P.R.China)

机构地区：[1]上海交通大学医学院苏州九龙医院胸外二科,江苏苏州215028 [2]南京医科大学附属苏州医院胸外科,江苏苏州215000

出　　处：《老年医学与保健》2024年第4期1003-1007,1013,共6页Geriatrics & Health Care

基　　金：2022年苏州市医学创新应用研究(SKY2022094);2023年苏州市医学创新应用研究(SKY2023203)。

摘　　要：目的探讨老年患者3D单孔胸腔镜单向式解剖性右肺上叶切除术的学习曲线。方法回顾性分析2021年1月—2022年12月收治的53例非小细胞肺癌老年患者的临床资料,采用CUSUM分析对3D单孔胸腔镜单向式解剖性右肺上叶切除术的学习曲线进行分析。结果平均手术时间为(155.15±31.13)min(100230 min);学习曲线的截点值等于23,提示术者至少需经历23例手术才能逐步熟练掌握该术式。将53例患者按照学习曲线的截点值分为A组和B组,A组在手术时间、术中出血量、术后住院时间等明显多于B组,差异均有统计学意义(均P<0.05)。2组在淋巴结清扫数量、术后切口疼痛评分(术后24、48 h)、术后24 h引流量、胸管留置时间、术后并发症等差异均无统计学意义(均P>0.05)。结论跨越学习曲线达到熟练操作可能约需累积23例手术经验。Objective To explore the learning curve of single-direction anatomical right upper lobectomy by 3D uniportal video-assisted thoracoscopy in elderly patients.Methods The clinical data of 53 elderly patients with non-small cell lung cancer admitted from January 2021 to December 2022 were retrospectively analyzed.CUSUM analysis was used to analyze the learning curve of single-direction anatomical right upper lobectomy by 3D uniportal video-assisted thoracoscopy.Results The average operation time was(155.15±31.13)min(100230 min).The cut-off value of the learning curve was 23,which indicated that the surgeon needed to undergo at least 23 surgeries to gradually master the technique.The 53 patients were divided into group A and group B according to the cut-off value of the learning curve.The group A had significantly longer operation time,greater intraoperative blood loss,and longer postoperative hospital stay than those of the group B,and the differences were statistically significant(all P<0.05).There were no significant differences between the two groups in the number of lymph nodes dissection,postoperative incision pain score(24 h and 48 h after surgery),drainage volume 24 h after surgery,thoracic tube retention time,and postoperative complications(all P>0.05).Conclusion It may require accumulating approximately 23 surgical experiences to cross the learning curve to achieve skilled operation.

关 键 词：老年 肺癌 3D胸腔镜 单孔 单向式 肺叶切除术 学习曲线 

分 类 号：R734.2[医药卫生—肿瘤]