达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术的学习曲线研究  

Study of learning curve for Da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant

作　　者：陈阔 吕鹏威[1] CHEN Kuo;LÜPeng-wei(Department of Breast Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院乳腺外科,河南郑州450052

出　　处：《中国现代普通外科进展》2024年第11期873-876,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术的的学习曲线。方法:回顾性分析郑州大学第一附属医院乳腺外科2022年9月—2024年2月收治的103例乳腺癌患者的临床资料,采用累积和分析法(CUSUM)对达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术的手术学习时间进行分析,根据学习曲线的临界值,将达芬奇机器人的学习曲线分为不同的阶段,比较在不同学习阶段的相关数据,分析达芬奇机器人的学习曲线。结果:达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术平均机器人镜下操作手术时间为132.23 min,学习曲线最佳拟合方程为CUSUM=0.007x3-1.576x^(2)+75.923x+896.172(x为手术例数),拟合优度系数R^(2)=0.918,曲线最高点为第16例。前16例为学习探索组,后87例为稳定掌握组。结论:通过CUSUM分析达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术的学习曲线可以分为学习探索、稳定掌握2个阶段,达到稳定掌握阶段至少需累积16例手术经验。Objective:Exploring the learning curve of Da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant.Methods:The clinical data of 103 breast cancer patients completed from September 2022 to February 2024 in the Department of Breast Surgery of the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.The duration of operation was evaluated by cumulative sum analysis(CUSUM)to fit a learning curve.According to the critical value of the learning curve,the learning curve of da Vinci robot was divided into different stages.The relevant data of these patients in different learning stages were compared and the learning curve of Da Vinci robot was analyzed.Results:The operating time was 132.23 min of Da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant.The optimal curve-fitting equation was:CUSUM=0.007x3-1.576x^(2)+75.923x+896.172.The fitting curve reached the top after the 16th case,which suggested that the surgeons master the technique after they finished 16 cases.16 cases before the cut-off point were the learning group,and the other 87 cases were the proficiency group.Conclusions:The learning curve of Da Vinci robotic surgery can be divided into learning and proficiency stage.The minimum number of operations reaching proficiency stage of learning curve is 16 for the surgeons.

关 键 词：学习曲线 机器人手术 乳房重建 假体 累计和分析法 

分 类 号：R737.9[医药卫生—肿瘤]