CAJ | 학술논문

目的探讨胸腹腔镜联合食管癌根治术的学习曲线.方法回顾性分析2010年4月至2011年12月由同一治疗组医师完成的144例胸腹腔镜联合食管癌根治术.按照手术日期先后顺序分为A、B、C、D4组,每组36例.比较各组患者的手术时间,术中出血量,淋巴结清扫个数,中转开放手术率,并发症率,住院时间及手术频度,分析不同阶段的手术效果.结果 4组患者在年龄、性别、肿瘤侵犯深度,肿瘤位置,中转开放手术率,并发症发生率及手术后住院时间等方面差异均无统计学意义(P＞0.05).A组手术时间为(339.1 ± 56.5)min,显著长于B组(240.7±58.2)min、C组(255.4±45.7) min和D组(269.9 ±45.4) min,P＜0.05.A组的术中失血量为(218.6±142.9)min,显著多于B组(106.4±76.0)min、C组(75.5 ±48.7) min和D组(100.5±91.9) min,P＜0.05.B、C、D三组间差异无统计学意义(P＞0.05).A组清扫淋巴结的个数为(10.6±5.6)个,显著少于B组(15.6±7.7)个、C组(18.3±6.9)个和D组(18.4±8.7)个,(P＜0.05).B、C、D三组间差异无统计学意义(P＞0.05).手术频度由A组的3.9例/月上升到B组的14.4例/月、C组的11.1例/月、D组的10.6例/月,并趋于稳定.结论胸腹腔镜联合食管癌根治术学习曲线大约为36例.
목적 탐토흉복강경연합식관암근치술적학습곡선.방법 회고성분석2010년4월지2011년12월유동일치료조의사완성적144례흉복강경연합식관암근치술.안조수술일기선후순서분위A、B、C、D4조,매조36례.비교각조환자적수술시간,술중출혈량,림파결청소개수,중전개방수술솔,병발증솔,주원시간급수술빈도,분석불동계단적수술효과.결과 4조환자재년령、성별、종류침범심도,종류위치,중전개방수술솔,병발증발생솔급수술후주원시간등방면차이균무통계학의의(P＞0.05).A조수술시간위(339.1 ± 56.5)min,현저장우B조(240.7±58.2)min、C조(255.4±45.7) min화D조(269.9 ±45.4) min,P＜0.05.A조적술중실혈량위(218.6±142.9)min,현저다우B조(106.4±76.0)min、C조(75.5 ±48.7) min화D조(100.5±91.9) min,P＜0.05.B、C、D삼조간차이무통계학의의(P＞0.05).A조청소림파결적개수위(10.6±5.6)개,현저소우B조(15.6±7.7)개、C조(18.3±6.9)개화D조(18.4±8.7)개,(P＜0.05).B、C、D삼조간차이무통계학의의(P＞0.05).수술빈도유A조적3.9례/월상승도B조적14.4례/월、C조적11.1례/월、D조적10.6례/월,병추우은정.결론 흉복강경연합식관암근치술학습곡선대약위36례.
Objective Minimally invasive esophagectomy(MIE) is accepted as standard surgery for treatment of esophageal carcinoma.This study investigated the learning curve of Combining thoracoscopy and laparscopy for treatment of esophageal carcinoma.Methods We retrospectively analyzed the clinical data of 144 cases of combined thoracoscopic and laparoscopic esophagectomy performed by the same surgical team.In order of the dates of surgery,the patients were equally divided into groups A,B,C,and D.Comparisons were made among the four groups in operation time,blood loss,number of lymph nodes resected,rate of conversion to open surgery,postoperative complications,postoperative hospital stay,and frequency of surgery.Results No significant differences were found in age,sex,T stage,tumor location,rate of conversion to open surgery,rate of postoperative complications,and postoperative hospital stay among the five groups (P ＞ 0.05).The operation time was significantly longer in group A than in B,C and D[(339.1 ±56.5) min vs.(240.7 ±58.2) min,(255.4 ±45.7) min and (269.9 ±45.4) min,P＜0.05,and 5].The blood loss in surgery was significantly more in group A than the other three groups [(18.6 ±142.9 ml vs.(106.4 ±76.0) ml,(75.5 ±48.7) ml and (100.5 ±91.9) ml,P ＜0.05].The number of lymph nodes resected was significantly less in group A than the other three groups [(10.6 ± 5.6) vs.(15.6 ± 7.7),(18.3 ±6.9) and (18.4 ± 8.7),P ＜0.05].The frequency of surgery was increased from 3.9 cases a month in group A to 14.4,11.1 and 10.6 cases a month in B,C and D.Conclusion The learning curve of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma is about 36 cases.