机器人辅助肾移植术学习曲线探讨  

Exploration on the learning curve of robotic-assisted kidney transplantation

作　　者：谭顺成 崔建春 孙洵[1] 胡伟 周允冲 宋永琳[1] 李树欣 马寅锐 张亚飞 Tan Shuncheng;Cui Jianchun;Sun Xun;Hu Wei;Zhou Yunchong;Song Yonglin;Li Shuxin;Ma Yinrui;Zhang Yafei(Department of Urology,the First People's Hospital of Kunming,650011 Kunming,China)

机构地区：[1]昆明市第一人民医院泌尿外科,昆明650011

出　　处：《器官移植》2024年第6期928-934,共7页Organ Transplantation

基　　金：云南省科技厅重大科技专项计划项目(202302AA310018);昆明市卫生健康委员会科研项目(2022-04-05-003)。

摘　　要：目的探讨机器人辅助肾移植术(RAKT)的学习曲线。方法回顾性分析同一手术团队连续开展的96例RAKT患者的临床资料,选取动脉吻合时间、静脉吻合时间、输尿管吻合时间、住院时间、失血量作为评价指标,采用多因素累积和(CUSUM)分析RAKT的学习曲线,依据学习曲线图将其分为学习提高阶段和熟练掌握阶段,通过对比不同学习阶段患者的一般资料及手术资料验证学习曲线,分析各阶段临床疗效。结果学习曲线的最佳拟合方程在第33例时达到峰值,33例为掌握RAKT所需要累积的最少手术例数。学习提高阶段组和熟练掌握阶段组的年龄、性别、透析类型、既往腹部手术史、供肾动脉数量、术前血清肌酐差异无统计学意义(均为P>0.05)。与学习提高阶段比较,熟练掌握阶段体质量指数(BMI)较大,右侧供肾数量较左侧供肾增加(均为P<0.05)。两组动脉吻合时间、输尿管吻合时间、术后血清肌酐、并发症差异无统计学意义(均为P>0.05),熟练掌握阶段髂血管游离时间、热缺血时间、静脉吻合时间、失血量及住院时间优于学习提高阶段,差异均有统计学意义(均为P<0.05)。结论RAKT至少需要33例手术跨越学习曲线,学习提高阶段和熟练掌握阶段并发症和移植肾功能恢复无差异。Objective To explore the learning curve of robotic-assisted kidney transplantation(RAKT).Methods The clinical data of 96 consecutive RAKT patients performed by the same surgical team were retrospectively analyzed.The arterial anastomosis time,venous anastomosis time,ureteral anastomosis time,hospital stay,and blood loss wereselected as evaluation indicators.The learning curve of RAKT was analyzed using the cumulative sum(CUSUM),and thecurve was divided into the learning improvement stage and the proficient mastery stage according to the learning curve.The learning curve was verified by comparing the general data and surgical data of patients in different learning stages,and the clinical efficacy of each stage was analyzed.Results The optimal fitting equation of the learning curve reached itspeak at the 33rd case,which was the minimum number of surgeries required to master RAKT.There was no statisticallysignificant difference in age,gender,dialysis type,previous abdominal surgery history,number of donor renal arteries,andpreoperative serum creatinine between the learning improvement group and the proficient mastery group(all P>0.05).Compared with the learning improvement stage,the body mass index(BMI)was higher,and the number of right donorkidney was increased compared to the left donor kidney in the proficient mastery stage(both P<0.05).There were nosignificant differences in arterial anastomosis time,ureteral anastomosis time,postoperative serum creatinine,andcomplications between the two groups(all P>0.05).The iliac vessel dissection time,warm ischemia time,venous anastomosis time,blood loss,and hospital stay in the proficient mastery stage were superior to those in the learningimprovement stage,with statistically significant differences(all P<0.05).Conclusions RAKT requires at least 33 cases tocross the learning curve.There is no difference in complications and recovery of transplant renal function between thelearning improvement stage and the proficient mastery stage.

关 键 词：机器人 肾移植 学习曲线 累积和 血管吻合 输尿管吻合 血清肌酐 并发症 

分 类 号：R617[医药卫生—外科学] R692[医药卫生—临床医学]