目的 分析三孔法经腹膜外途径腹腔镜下根治性前列腺切除术(extraperitoneal laparoscopic radical prostatectomy,ELRP)的学习曲线,探讨如何缩短三孔法ELRP的手术时间,减少术中出血.方法 回顾性分析2013年8月至2014年10月收治时间连续的95例前列腺癌患者的临床资料.平均年龄(65.9±7.7)岁,平均总前列腺特异抗原(15.4±12.7) μg/L,平均体质指数(24.8±3.2) kg/m2.本组95例均由同一术者行三孔法ELRP,根据手术顺序分为3组:A组32例(第1～32例),B组32例(第33 ～64例),C组31例(第65 ～ 95例).3组的年龄、体质指数、术前总前列腺特异性抗原、前列腺体积、临床分期、术前是否行新辅助内分泌治疗、经尿道前列腺切除手术史等比较差异均无统计学意义(P＞0.05).分析手术例数与手术时间、术中出血量、术后住院天数、术后腹腔引流管留置时间、手术切缘情况、术后生化复发,以及术后3、6、12个月尿失禁发生率等围术期参数的相关性.分别比较A组与B、C组,以及A、B组与C组在围术期参数方面的差异.结果 本组95例平均手术时间(81.0±18.6) min.随着手术总例数增加,手术时间显著缩短(|r |=0.612,P＜0.01).A、B、C各组内随着手术例数增加,手术时间无明显变化(P＞0.05).A组手术时间为(96.4±11.3) min,显著长于B、C组平均手术时间(73.2±16.7) min,差异有统计学意义(P＜0.01).A、B组平均手术时间为(87.6±17.2) min,显著长于C组的(67.5±13.8) min,差异有统计学意义(P＜0.01).95例的平均术中出血量(102.6±75.8) ml,随着手术例数增加,术中出血量显著减少(|rs| =0.677,P＜0.01).A组内随着手术例数增加,术中出血量显著减少(|rs | =0.619,P＜0.01).在B、C组内,手术例数的增加与术中出血量的变化均无明显相关性(P＞0.05).A组术中出血量为(158.7±81.3) ml,显著多于B、C组平均出血量(74.1 ±54.4) ml,差异有统计学意义(P＜0.01).A、B组平均术中出血量为(125.5±71.6) ml,显著多于C组的(55.3 ±61.6) ml,差异有统计学意义(P＜0.01).本组95例总体以及3组内的术后住院天数、术后引流管留置时间均与手术例数增加无显著相关性(P＞0.05);随手术例数增加,手术切缘阳性率、术后生化复发率、术后尿失禁发生率等无显著变化(P＞0.05).结论 有丰富腹腔镜手术经验的医师,经过约32例三孔法ELRP后,手术时间可以显著缩短,术中出血量显著减少;经过约64例后,手术时间和术中出血量可进一步降低.
目的 分析三孔法經腹膜外途徑腹腔鏡下根治性前列腺切除術(extraperitoneal laparoscopic radical prostatectomy,ELRP)的學習麯線,探討如何縮短三孔法ELRP的手術時間,減少術中齣血.方法 迴顧性分析2013年8月至2014年10月收治時間連續的95例前列腺癌患者的臨床資料.平均年齡(65.9±7.7)歲,平均總前列腺特異抗原(15.4±12.7) μg/L,平均體質指數(24.8±3.2) kg/m2.本組95例均由同一術者行三孔法ELRP,根據手術順序分為3組:A組32例(第1～32例),B組32例(第33 ～64例),C組31例(第65 ～ 95例).3組的年齡、體質指數、術前總前列腺特異性抗原、前列腺體積、臨床分期、術前是否行新輔助內分泌治療、經尿道前列腺切除手術史等比較差異均無統計學意義(P＞0.05).分析手術例數與手術時間、術中齣血量、術後住院天數、術後腹腔引流管留置時間、手術切緣情況、術後生化複髮,以及術後3、6、12箇月尿失禁髮生率等圍術期參數的相關性.分彆比較A組與B、C組,以及A、B組與C組在圍術期參數方麵的差異.結果 本組95例平均手術時間(81.0±18.6) min.隨著手術總例數增加,手術時間顯著縮短(|r |=0.612,P＜0.01).A、B、C各組內隨著手術例數增加,手術時間無明顯變化(P＞0.05).A組手術時間為(96.4±11.3) min,顯著長于B、C組平均手術時間(73.2±16.7) min,差異有統計學意義(P＜0.01).A、B組平均手術時間為(87.6±17.2) min,顯著長于C組的(67.5±13.8) min,差異有統計學意義(P＜0.01).95例的平均術中齣血量(102.6±75.8) ml,隨著手術例數增加,術中齣血量顯著減少(|rs| =0.677,P＜0.01).A組內隨著手術例數增加,術中齣血量顯著減少(|rs | =0.619,P＜0.01).在B、C組內,手術例數的增加與術中齣血量的變化均無明顯相關性(P＞0.05).A組術中齣血量為(158.7±81.3) ml,顯著多于B、C組平均齣血量(74.1 ±54.4) ml,差異有統計學意義(P＜0.01).A、B組平均術中齣血量為(125.5±71.6) ml,顯著多于C組的(55.3 ±61.6) ml,差異有統計學意義(P＜0.01).本組95例總體以及3組內的術後住院天數、術後引流管留置時間均與手術例數增加無顯著相關性(P＞0.05);隨手術例數增加,手術切緣暘性率、術後生化複髮率、術後尿失禁髮生率等無顯著變化(P＞0.05).結論 有豐富腹腔鏡手術經驗的醫師,經過約32例三孔法ELRP後,手術時間可以顯著縮短,術中齣血量顯著減少;經過約64例後,手術時間和術中齣血量可進一步降低.
목적 분석삼공법경복막외도경복강경하근치성전렬선절제술(extraperitoneal laparoscopic radical prostatectomy,ELRP)적학습곡선,탐토여하축단삼공법ELRP적수술시간,감소술중출혈.방법 회고성분석2013년8월지2014년10월수치시간련속적95례전렬선암환자적림상자료.평균년령(65.9±7.7)세,평균총전렬선특이항원(15.4±12.7) μg/L,평균체질지수(24.8±3.2) kg/m2.본조95례균유동일술자행삼공법ELRP,근거수술순서분위3조:A조32례(제1～32례),B조32례(제33 ～64례),C조31례(제65 ～ 95례).3조적년령、체질지수、술전총전렬선특이성항원、전렬선체적、림상분기、술전시부행신보조내분비치료、경뇨도전렬선절제수술사등비교차이균무통계학의의(P＞0.05).분석수술례수여수술시간、술중출혈량、술후주원천수、술후복강인류관류치시간、수술절연정황、술후생화복발,이급술후3、6、12개월뇨실금발생솔등위술기삼수적상관성.분별비교A조여B、C조,이급A、B조여C조재위술기삼수방면적차이.결과 본조95례평균수술시간(81.0±18.6) min.수착수술총례수증가,수술시간현저축단(|r |=0.612,P＜0.01).A、B、C각조내수착수술례수증가,수술시간무명현변화(P＞0.05).A조수술시간위(96.4±11.3) min,현저장우B、C조평균수술시간(73.2±16.7) min,차이유통계학의의(P＜0.01).A、B조평균수술시간위(87.6±17.2) min,현저장우C조적(67.5±13.8) min,차이유통계학의의(P＜0.01).95례적평균술중출혈량(102.6±75.8) ml,수착수술례수증가,술중출혈량현저감소(|rs| =0.677,P＜0.01).A조내수착수술례수증가,술중출혈량현저감소(|rs | =0.619,P＜0.01).재B、C조내,수술례수적증가여술중출혈량적변화균무명현상관성(P＞0.05).A조술중출혈량위(158.7±81.3) ml,현저다우B、C조평균출혈량(74.1 ±54.4) ml,차이유통계학의의(P＜0.01).A、B조평균술중출혈량위(125.5±71.6) ml,현저다우C조적(55.3 ±61.6) ml,차이유통계학의의(P＜0.01).본조95례총체이급3조내적술후주원천수、술후인류관류치시간균여수술례수증가무현저상관성(P＞0.05);수수술례수증가,수술절연양성솔、술후생화복발솔、술후뇨실금발생솔등무현저변화(P＞0.05).결론 유봉부복강경수술경험적의사,경과약32례삼공법ELRP후,수술시간가이현저축단,술중출혈량현저감소;경과약64례후,수술시간화술중출혈량가진일보강저.
Objective To evaluate the learning curve of three-port extraperitoneal laparoscopic radical prostatectomy(ELRP) and to minimize operative time and blood loss about this procedure.Methods From August 2013 to October 2014,the data from 95 consecutive patients,who had undergone three-port ELRP for prostate cancer,were retrospectively analyzed.The mean age was 65.9 ± 7.7 years,mean total PSA level was 15.4 ± 12.7 μg/L,and mean body mass index(BMI) was 24.8 ± 3.2 kg/m2.According to the number of procedures performed by the surgeon,all patients were classified into three chronologic groups,including group A (No.1-32),group B (No.33-64) and group C (No.65-95).There were no significant differences including age,BMI,tPSA,estimated prostate volume,clinical stages,history of neoadjuvant endocrine therapy,history of transurethral resection of the prostate (TURP) among group A,B and C (P ＞ 0.05).The operative outcomes analyzed were operative time,estimated blood loss,hospital stay,drainage tube indwelling days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates.Among these 95 patients,the results of the first 32 cases were compared with those of the remaining 63 cases,the first 64 with the remaining 31.Results The average operative time in 95 patients was 81.0 ± 18.6 min.The sloping learning curve for this surgeon showed that the operative time for all 95 cases was strongly correlated with additional experience (| rs | =0.612,P＜0.01).Operative time,however,was not strongly correlated with the surgeon's experience in each group of A,B and C(P ＞0.05).Group A had longer operative time than that of Group B plus C(96.4 ± 11.3 min vs 73.2 ± 16.7 min,P ＜0.01).Group A plus B had longer operative time than that of group C (87.6 ± 17.2 min vs 67.5 ± 13.8 min,P ＜ 0.01).For all cases,the estimated blood loss was strongly correlated with additional experience (| rs | =0.677,P ＜ 0.01).Estimated blood loss was strongly correlated with the accumulation of experience for the initial 32 cases(| rs | =0.619,P ＜ 0.01).However,no strong correlation was observed over the next 63 cases.Group A had more blood loss than that of Group B plus C (158.7 ± 81.3 ml vs 74.1 ± 54.4 ml,P ＜ 0.01).Group A plus B had more blood loss than that of group C (125.5 ± 71.6 ml vs 55.3 ± 61.6 ml,P ＜ 0.01).But hospital stay,drainage tube keeping days were not strongly correlated with additional experience in each group(P ＞ 0.05).There were no significant correlation between the accumulation of experience and positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates.Conclusion Our experience of three-port ELRP cases appears to be favorable with decreasing tendency in operative time,estimated blood loss with experience accumulation.Exposure to 32 surgeries,operative time and estimated blood loss reduced significantly,and after 64 cases operative time and estimated blood loss further reduced.
