摘要
目的探讨磁锚定两孔法腹腔镜胆囊切除术(LC)的学习曲线,总结该手术学习经验。方法回顾性分析2019年6月至2021年9月在西安交通大学第一附属医院行磁锚定两孔法LC的110例患者临床资料。手术由同一组有丰富LC手术经验的医师完成。患者均签署知情同意书,符合医学伦理学规定。其中男34例,女76例;年龄20~74岁,中位年龄44岁。原发病:胆囊结石合并慢性胆囊炎81例,胆囊结石合并慢性胆囊炎急性发作6例,胆囊结石合并胆囊息肉8例,单纯胆囊息肉15例。采用累积和分析法及最佳拟合曲线制作学习曲线,观察不同学习期患者情况。两组手术时间比较采用t检验。结果所有患者均成功实施磁锚定两孔法LC,无中转三孔法及开腹手术。患者平均手术时间(40±11)min。学习曲线分为2个阶段,37例以前为学习期,37例以后进入稳定期。学习期时间跨度为12个月。手术时间由学习期的(53±9)min降至稳定期的(34±6)min,差异有统计学意义(t=11.323,P<0.05)。所有患者均无术中胆道及动脉损伤,无胆漏、胆道狭窄、出血、感染等术后并发症,无术后1个月再入院。结论磁锚定两孔法LC学习过程安全,对于有丰富LC手术经验的医师,通过12个月37例手术学习期积累即可熟练掌握,适合在临床推广应用。
Objective To analyze the learning curve of magnetic anchoring two-port laparoscopic cholecystectomy(LC)and to summarize the learning experience of this operation.Methods Clinical data of 110 patients who underwent magnetic anchoring two-port LC in the First Affiliated Hospital of Xi'an Jiaotong University from June 2019 to September 2021 were retrospectively analyzed.The surgery was performed by the same group of experienced LC surgeons.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,34 patients were male and 76 female,aged from 20 to 74 years,with a median age of 44 years.Regarding primary diseases,81 patients were diagnosed with cholecystolithiasis complicated with chronic cholecystitis,6 cases of cholecystolithiasis complicated with acute-on-chronic cholecystitis,8 cases of cholecystolithiasis complicated with gallbladder polyp and15 cases of simple gallbladder polyp.The learning curve was delineated by cumulative sum method and the best fitting curve.The conditions of patients during different learning stages were observed.The operation time between two groups was compared by t test.Results All patients successfully underwent magnetic anchoring two-port LC without conversion to three-port LC or open surgery.The average operation time was(40±11)min.The learning curve was divided into 2 stages,the learning stage when LC were performed in within 37 cases and the stable stage when LC were performed in beyond 37 cases.The learning stage endured for 12 months.In the learning stage,the operation time was(53±9)min,and(34±6)min in the stable stage,where significant difference was observed(t=11.323,P<0.05).No intraoperative bile duct and artery injury,bile leakage,bile duct stenosis,bleeding,infection or other postoperative complications occurred.No patient was re-hospitalized at postoperative 1 month.Conclusions The learning process of magnetic anchoring two-port LC is safe.Experienced LC surgeons can complete this procedure after performing 37 cases of LC during the 12-month learning stage,which is feasible for clinical application.
作者
张苗苗
雷蕾
徐庶钦
冒健骐
白纪刚
耿智敏
吕毅
严小鹏
Zhang Miaomiao;Lei Lei;Xu Shuqin;Mao Jianqi;Bai Jigang;Geng Zhimin;Lyu Yi;Yan Xiaopeng(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;National and Local Joint Engineering Research Center of Precision Surgery&Regenerative Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Zonglian College,Xi'an Jiaotong University,Xi'an 710061,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2023年第1期77-81,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
陕西省创新能力支撑计划青年科技新星项目(2020KJXX-022)
陕西省重点研发计划一般项目-社会发展领域(2021SF-163)
西安交通大学第一附属医院新医疗新技术项目(XJYFY-2018W18)。
关键词
磁锚定技术
磁外科
胆囊切除术
腹腔镜
学习曲线
Magnetic anchoring technique
Magnetosurgery
Cholecystectomy,laparoscopic
Learning curve
