安徽医药
安徽醫藥
안휘의약
ANHUI MEDICAL AND PHARMACEUTICAL JOURNAL
2015年
1期
61-65,66
,共6页
腹腔镜%宫颈癌%广泛全子宫%盆腔淋巴结清扫%学习曲线
腹腔鏡%宮頸癌%廣汎全子宮%盆腔淋巴結清掃%學習麯線
복강경%궁경암%엄범전자궁%분강림파결청소%학습곡선
peritoneoscope%cervical cancer%uterus%pelvic lymph node cleaning%learning curve
目的：通过分析比较腹腔镜宫颈癌根治术的围手术期相关结果来绘制其学习曲线，大致评估腹腔镜宫颈癌根治术的困难程度，为妇科恶性肿瘤特别是宫颈癌的腹腔镜手术的学习提供参考依据。方法回顾性分析该院40例腹腔镜下广泛全子宫加盆腔淋巴结清扫患者的临床资料。按手术日期的先后顺序分为4个手术阶段。比较各阶段平均手术时间、术中平均出血量、中转开腹率、围手术期输血率、淋巴清扫数目、术后病率、术后感染率、手术并发症、术后平均住院时间，进行统计学分析，了解不同时间段的手术效果，并以简单正弦拟合学习曲线。结果各阶段手术时间、术中出血量均呈下降趋势，进一步两两比较，手术时间仅Ⅲ、Ⅳ阶段手术时间无统计学差异（P ＝0．5275）；术中出血量仅Ⅰ阶段术中出血量（470±59．98）mL 明显多于Ⅳ阶段（317．0±25．52）mL（P ＝0．0306）。围手术期输血率呈持续下降趋势；各阶段术后平均住院时间、淋巴清扫数目、术后病率、术后感染率比较差异无统计学意义（P ＞0．05）；总共仅1例手术并发症发生（输尿管阴道瘘，I 阶段），无1例中转开腹。以简单的振荡正弦曲线 Y＝sinx －π／2拟合移动平均线，手术时间的拐点为19例，术中出血量的拐点为23例。结论腹腔镜广泛全子宫加盆腔淋巴结清扫的学习曲线大约为20例，即可达到较熟练的水平且趋于稳定。
目的：通過分析比較腹腔鏡宮頸癌根治術的圍手術期相關結果來繪製其學習麯線，大緻評估腹腔鏡宮頸癌根治術的睏難程度，為婦科噁性腫瘤特彆是宮頸癌的腹腔鏡手術的學習提供參攷依據。方法迴顧性分析該院40例腹腔鏡下廣汎全子宮加盆腔淋巴結清掃患者的臨床資料。按手術日期的先後順序分為4箇手術階段。比較各階段平均手術時間、術中平均齣血量、中轉開腹率、圍手術期輸血率、淋巴清掃數目、術後病率、術後感染率、手術併髮癥、術後平均住院時間，進行統計學分析，瞭解不同時間段的手術效果，併以簡單正絃擬閤學習麯線。結果各階段手術時間、術中齣血量均呈下降趨勢，進一步兩兩比較，手術時間僅Ⅲ、Ⅳ階段手術時間無統計學差異（P ＝0．5275）；術中齣血量僅Ⅰ階段術中齣血量（470±59．98）mL 明顯多于Ⅳ階段（317．0±25．52）mL（P ＝0．0306）。圍手術期輸血率呈持續下降趨勢；各階段術後平均住院時間、淋巴清掃數目、術後病率、術後感染率比較差異無統計學意義（P ＞0．05）；總共僅1例手術併髮癥髮生（輸尿管陰道瘺，I 階段），無1例中轉開腹。以簡單的振盪正絃麯線 Y＝sinx －π／2擬閤移動平均線，手術時間的枴點為19例，術中齣血量的枴點為23例。結論腹腔鏡廣汎全子宮加盆腔淋巴結清掃的學習麯線大約為20例，即可達到較熟練的水平且趨于穩定。
목적：통과분석비교복강경궁경암근치술적위수술기상관결과래회제기학습곡선，대치평고복강경궁경암근치술적곤난정도，위부과악성종류특별시궁경암적복강경수술적학습제공삼고의거。방법회고성분석해원40례복강경하엄범전자궁가분강림파결청소환자적림상자료。안수술일기적선후순서분위4개수술계단。비교각계단평균수술시간、술중평균출혈량、중전개복솔、위수술기수혈솔、림파청소수목、술후병솔、술후감염솔、수술병발증、술후평균주원시간，진행통계학분석，료해불동시간단적수술효과，병이간단정현의합학습곡선。결과각계단수술시간、술중출혈량균정하강추세，진일보량량비교，수술시간부Ⅲ、Ⅳ계단수술시간무통계학차이（P ＝0．5275）；술중출혈량부Ⅰ계단술중출혈량（470±59．98）mL 명현다우Ⅳ계단（317．0±25．52）mL（P ＝0．0306）。위수술기수혈솔정지속하강추세；각계단술후평균주원시간、림파청소수목、술후병솔、술후감염솔비교차이무통계학의의（P ＞0．05）；총공부1례수술병발증발생（수뇨관음도루，I 계단），무1례중전개복。이간단적진탕정현곡선 Y＝sinx －π／2의합이동평균선，수술시간적괴점위19례，술중출혈량적괴점위23례。결론복강경엄범전자궁가분강림파결청소적학습곡선대약위20례，즉가체도교숙련적수평차추우은정。
Objective To assess the difficulty of peritoneoscopic radical hysterectomy of cervical cancer by constructing leaming curves,so as to provide reference for the study of gynecologic malignancies especially peritoneoscopic surgery for cervical cancer.Meth-ods A retrospective analysis was made of the clinical data of 40 cases of peritoneoscopic hysterectomy and extensive pelvic lymphade-nectomy in The Affiliated Provincial Hospital of Anhui Medical University.The surgery was assigned into four stages according to the surgery date order,and we compared the results in different stages,which included average time,intraoperative blood loss,transit opera-tion rate,perioperative blood transfusion rate,number of lymph node cleaning,disease rate after operation,postoperative infection,surgi-cal complications and the average length of hospital stay.These results were statistically analyzed to get to know the surgical effect at different stages and the learning curve was obtained.Results The operation time,intraoperative blood loss are declining at each stage. By further comparison,there was no statistical difference in the operation time only between stage III and IV (P =0.527 5).The bleed-ing amount of intraoperative blood loss at stage I was significantly more than that at stage IV [(470 ±59.98)mL vs (317.0 ±25.52) mL](P =0.030 6).Perioperative blood transfusion rate showed a falling trend.There were no statistical significance in the average postoperative hospital stay,number of lymph node cleaning,disease rate after operation and postoperative infection between stages (P >0.05).There was only 1 case of surgical complication (vaginal ureter fistula,phase I).No case transferred to laparotomy.With simple oscillation sine curve Y=sinx-π/2 fitting moving averages,the inflexion point of operation time could be found in 19 cases,and that of intraoperative blood loss was found in 23 cases.Conclusions The learning curve of peritoneoscopic radical hysterectomy of cervical cancer is approximately 20 cases,which can achieve a level of proficiency and consistency.
