腔镜技术基础对无充气腋窝入路腔镜下甲状腺手术学习曲线的影响  

Impact of the basic skills of endoscopic technology on the learning curve of gasless transaxillary posterior endoscopic thyroidectomy

作　　者：孙平 张玉帅 何润东 张帅[1] 边学海[1] 付庆锋[1] 张大奇[1] 付言涛[1] 孙辉[1] 周乐[1] Sun Ping;Zhang Yushuai;He Rundong;Zhang Shuai;Bian Xuehai;Fu Qingfeng;Zhang Daqi;Fu Yantao;Sun Hui;Zhou Le(Department of Thyroid Surgery,China-japan Union Hospital of Jilin University,Jilin Provincial Key Laboratory of Translational Medicine of Surgery,Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Treatment,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院甲状腺外科、吉林省外科转化医学重点实验室、吉林省甲状腺疾病防治工程实验室,长春130033

出　　处：《中华内分泌外科杂志(中英文)》2025年第1期35-39,共5页Chinese Journal of Endocrine Surgery

基　　金：吉林省财政厅项目(2019SCZ029)。

摘　　要：目的:探讨提升无充气腋窝入路腔镜下甲状腺手术(GUA)学习曲线的相关因素,评估腔镜技术基础对学习曲线的影响。方法:回顾性分析2023年4月至2023年12月吉林大学中日联谊医院甲状腺外科由一位有经胸乳入路腔镜下甲状腺手术基础医师最初完成的50例GUA患者与一位无腔镜技术基础医师最初完成的50例GUA患者的临床资料,分为腔镜基础组与无腔镜基础组,应用累积和法(CUSUM)分别构建学习曲线划分技术探索期与掌握期,分析比较两组及两个阶段的手术时间、术后第一日引流量,中央区淋巴结清扫数目及术后并发症。结果:根据CUSUM的趋势区分为技术探索期和技术掌握期,腔镜基础组学习曲线截点为15例,无腔镜基础组学习曲线截点为18例。两组在探索期的手术时间明显长于掌握期[(183.46±36.13)min比(144.40±26.14)min,P<0.001;(186.89±48.91)min比(131.59±22.90)min;P<0.001],腔镜基础组在掌握期的手术时间长于无腔镜基础组[(144.40±26.15)min比(131.59±22.90)min,P<0.05];腔镜基础组的术后引流量在两个阶段均低于无腔镜基础组[(65.40±32.48)mL比(93.22±30.67)mL,P<0.05;(57.40±15.35)mL比(78.50±28.30)mL,P<0.05],无腔镜基础组在掌握期的术后引流量明显低于探索期[(93.22±30.67)mL比(78.50±28.30)mL,P<0.05]。两组两个阶段中央区淋巴结清扫数目及术后并发症差异均无统计学意义。结论:GUA初期阶段有特定的学习曲线,跨越学习曲线之后,手术时间随着术者操作要点的改进而明显缩短;开展初期的腔镜技术基础可减少术后引流量的发生,但对学习曲线的影响较小。Objective:To evaluate the relevant factors to optimize the learning curve and the impact of the basic skills of endoscopic technology on the learning curve of gasless transaxillary posterior endoscopic thyroidectomy.Methods:A retrospective analysis was performed to evaluate the clinical outcomes of 50 patients who underwent Glandular Ultrasound-Assisted(GUA)thyroid surgery by a surgeon with a background in endoscopic thyroid surgery via the thoracic-areolar approach,and 50 patients operated on by a surgeon without such experience at the Thyroid Surgery Department of Jilin University China-Japan Union Hospital from Apr.to Dec.2023.The patients were divided into two groups:the Endoscopic Experience Group and the Non-Endoscopic Experience Group.The Cumulative Sum Control Chart(CUSUM)was applied to construct learning curves for both groups,dividing the technical exploration period from the mastery period.The analysis compared the surgical time,postoperative first-day drainage volume,number of central lymph nodes dissected rates,and postoperative complications between the two groups and across the two phases.Results:The analysis of the learning curve revealed that the inflection point of the Endoscopic Experience Group was 15,while of the Non-Endoscopic Experience Group was 18.The learning curve was divided into the technical exploration stage and the proficient mastery stage.The operative time of technical exploration stagde was significantly longer than of proficient mastery stage of both group(183.46±36.13min vs.144.40±26.14min,P<0.001;186.89±48.91min vs.131.59±22.90min;P<0.001).The operative time in the proficient mastery stage of the Endoscopic Experience Group was longer than that of the Non-Endoscopic Experience Group(144.40±26.15min vs.131.59±22.90min,P<0.05).The postoperative drainage volume in the Endoscopic Experience Group was lower than that in Non-Endoscopic Experience Group in both stages(65.40±32.48mL vs.93.22±30.67mL,57.40±15.35mL vs.78.50±28.30mL,P<0.05),and the postoperative drainage volum

关 键 词：甲状腺 甲状腺切除术 腔镜手术 腋窝入路 学习曲线 

分 类 号：R73[医药卫生—肿瘤]