[1]刘安伟,贾高臻,张振声,等.腹腔镜下根治性膀胱切除术学习曲线的研究[J].中华腔镜泌尿外科杂志(电子版),2016,10(06):373-378.[doi:10.3877/cma.j.issn.1674-3253.2016.06.002 ]
 Liu Anwei,Jia Gaozhen,Zhang Zhensheng,et al.The learning curve for laparoscopic radical cystectomy[J].,2016,10(06):373-378.[doi:10.3877/cma.j.issn.1674-3253.2016.06.002 ]
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腹腔镜下根治性膀胱切除术学习曲线的研究()
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中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
10
期数:
2016年06期
页码:
373-378
栏目:
临床研究
出版日期:
2016-12-31

文章信息/Info

Title:
The learning curve for laparoscopic radical cystectomy
作者:
刘安伟贾高臻张振声徐伟东杨波孙颖浩许传亮
200433上海,第二军医大学附属长海医院泌尿外科
Author(s):
Liu Anwei Jia Gaozhen Zhang Zhensheng Xu Weidong Yang Bo Sun Yinghao Xu Chuanliang.
Department of Urology, Changhai Hospital of The Second Military Medical University, Shanghai 200433, China
关键词:
膀胱肿瘤膀胱切除术腹腔镜学习曲线
DOI:
10.3877/cma.j.issn.1674-3253.2016.06.002
摘要:
目的探讨腹腔镜下根治性膀胱切除术( LRC)的学习曲线。方法回顾性统计分析 2011年 1月至 2015年 12月于第二军医大学附属长海医院行 LRC的患者共 80例,其中男性 70例,女性 10例,年龄范围 27~84岁,中位年龄 63.5岁,既往腹部手术史 11例。病理分期: <T2期 32例, T2期 27例,T3期 15例,T4期 6例。其中输尿管皮肤造口 19例,Bricker术 53例,原位新膀胱术 8例。按照手术时间先后顺序,分成 A(第 1~20例),B(第 21~40例),C(第 31~60例),D(第 61~80例)四组。四组患者在性别构成、年龄、腹部手术史、尿流改道方式及肿瘤分期上差异均无统计学意义( P>0.05),比较各组手术时间、术中出血量、术后住院天数、清扫淋巴结数量等指标,并观察各指标的变化趋势。结果手术均顺利完成,无中转开放。四组患者在手术时间、术中出血量、术后住院天数及清扫淋巴结数量上差异均具有统计学意义( P<0.05)。各组手术切缘均为阴性,并发症发生率的差别无统计学意义(P>0.05)。进一步两两比较结果显示,A组与 B组比较,手术时间、清扫淋巴结数量上的差异无统计学意义( P<0.05),但在术中出血量、术后住院天数上的差异均具有统计学意义( P<0.05)。B组与 C组仅在手术时间、清扫淋巴结数量上差异具有统计学意义( P<0.05),B组和 D组比较,四类指标之间的差异均具有统计学意义( P>0.05)。C组与 D组比较,手术时间及清扫淋巴结数量上无统计学差异( P>0. 05),而在出血量和术后住院天数上的差异具有统计学意义( P<0.05)。手术时间、术中出血量及术后住院天数随着手术例数的增加而逐渐下降,清扫淋巴结的数量则不断上升。结论 LRC具有明显的学习曲线,单个术者约行 30例 LRC手术后,手术时间及清扫淋巴结数量的学习曲线方能趋于稳定状态。而术中出血量及术后住院天数随着手术例数的不断增加呈阶梯状下降, 40例 LRC手术后降至最低水平,术者操作的熟练程度能够得到进一步的提升。

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金( 81572509)
通讯作者:许传亮,Email:chuanliang_xu@126.com
更新日期/Last Update: 2016-12-30