CAJ | 학술논문

目的分析单向式全胸腔镜肺癌切除术的学习曲线.方法前瞻性收集2006年5月至2009年4月由两名医师完成的125例全胸腔镜肺癌切除术的临床资料.将手术病例按主刀医师分为A(n=24)、B(n=101)两组,并将B组按时间顺序根据患者例数分为B1(n=25)、B2(n=25)、B3(n=25)、B4(n=26)组.A组手术医师开展胸腔镜手术2年,B组手术医师开展胸腔镜手术5年.比较各组的手术时间、术中失血量、清扫淋巴结数目、中转开胸率、术后并发症发生率.结果与B组比较,A组手术时间较长[(237±85)min比(187±43)min,P=0.013],而术中失血量、清扫淋巴结数目、中转开胸率、术后并发症发生率两组间差异无统计学意义(P＜0.05).A组与B1组比较也有相同结果.B组中从B1组到B4组手术时间逐渐缩短、术中失血量逐渐减少,但差异无统计学意义(P＜0.05).而B组中前50例(B1+B2)与后51例(B3+B4)比较术中失血量减少[(122±141)ml比(87±81),P=0.009].结论在开展完全胸腔镜肺癌切除的早期阶段,手术时间会较长,这在腔镜手术经历较短的医生更明显,但并发症发生率无显著增加.完成50例全胸腔镜肺癌切除手术可作为评价熟练掌握该手术的指标.
목적 분석단향식전흉강경폐암절제술적학습곡선.방법 전첨성수집2006년5월지2009년4월유량명의사완성적125례전흉강경폐암절제술적림상자료.장수술병례안주도의사분위A(n=24)、B(n=101)량조,병장B조안시간순서근거환자례수분위B1(n=25)、B2(n=25)、B3(n=25)、B4(n=26)조.A조수술의사개전흉강경수술2년,B조수술의사개전흉강경수술5년.비교각조적수술시간、술중실혈량、청소림파결수목、중전개흉솔、술후병발증발생솔.결과 여B조비교,A조수술시간교장[(237±85)min비(187±43)min,P=0.013],이술중실혈량、청소림파결수목、중전개흉솔、술후병발증발생솔량조간차이무통계학의의(P＜0.05).A조여B1조비교야유상동결과.B조중종B1조도B4조수술시간축점축단、술중실혈량축점감소,단차이무통계학의의(P＜0.05).이B조중전50례(B1+B2)여후51례(B3+B4)비교술중실혈량감소[(122±141)ml비(87±81),P=0.009].결론 재개전완전흉강경폐암절제적조기계단,수술시간회교장,저재강경수술경력교단적의생경명현,단병발증발생솔무현저증가.완성50례전흉강경폐암절제수술가작위평개숙련장악해수술적지표.
Objective To analyze the learning curve of single-direction complete video-assisted thoracoscopic surgery (cVATS) for lung cancer. Methods From May 2006 to April 2009, 125 cases of cVATS for lung cancer were performed by two dedicated surgeons. Clinical data were collected prospectively and analyzed retrospectively. The patients operated by different surgeon were divided into 2 groups (group A, n = 24; group B, n = 101) , and group B was further divided sequentially into 4 subgroups ( Bl, B2, B3 and B4) by the number of patients. The patients in group A and B were operated by the surgeons with 2-year and 5-year experience of VATS respectively. The operating time, blood loss, number of resected lymph nodes (NLN ), rate of thoracotomy conversion ( RTC ) and postoperative complications ( POC ) were compared. Results Compared with group B, the operating time of group A was significantly prolonged [(237 ± 85) min vs. (187 ± 43) min, P = 0. 013] , but there were no significant differences in blood loss, NLN, RTC and POC. Comparing group A with Bl, the same results were got. From group Bl to B4, the operating time was gradually reduced and blood loss decreased, but the difference was not statistically significant. And in group B, there was a significant reduction of blood loss for the last 51 cases compared to the first 50 cases [(122 ± 141) ml vs. (87 ± 81) ml, P = 0.009]. Conclusions At the early stage of cVATS resection of lung cancer, the duration of operation was longer, which it was more significant for the surgeons with short carrier of thoracoscopic experience. But the morbidity of operation related complications did not increase. The indicator of proficiency in this operation is achievement of 50 cases of complete thoracoscopic resection of lung cancer.