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目的:探讨手术频率对于腹腔镜胃癌根治术学习曲线的影响。方法:回顾性分析由同一组甲医师(n=100例,月平均手术3.33例)、乙医师(n=90例,月平均手术2.50例)分别在2008年1月～2010年6月和2008年1月～2011年1月完成的腹腔镜胃癌根治手术。按照手术先后顺序,将甲医师组分为4阶段(A、B、C、D),每阶段25例,乙医师组分为6阶段(E、F、G、H、I、J),每阶段15例。分别比较甲、乙医师组内各阶段及甲乙医师两组的手术时间、术中出血量、术后住院天数、并发症、中转开腹数、淋巴结清扫数。结果:所有分组比较的手术患者年龄、性别、病理分期、手术方式上均具有可比性。甲医师组C、D阶段手术时间及出血量显著少于A、B阶段,乙医师组I、J阶段手术时间及出血量显著少于E、F、G、H阶段,各阶段间淋巴结清扫数、并发症、术后住院天数及中转开腹率差异无统计学意义。甲医师组手术时间显著少于乙医师组手术时间,甲医师组术中出血量显著少于乙医师组术中出血量,两者差异具有统计学意义,两医师组间淋巴结清扫数、中转开腹率、手术并发症差异无统计学意义。结论:当适当增加手术频率时,可以在较短的学习曲线下,更好地掌握腹腔镜胃癌根治术。
Objective: To investigate the effect of surgical frequency on learning curve of laparoscopic radical gastrectomy. Methods: A retrospective analysis was performed in the same group of A physicians (n = 100, average of 3.33 cases per month), B physician (n = 90 cases, average of 2.50 cases per month) from January 2008 to June 2010 and 2008 January 2011 ~ January 2011 completed laparoscopic radical gastrectomy. According to the order of the operation, the A group was divided into 4 stages (A, B, C, D), 25 cases in each stage and 6 stages in the B group (E, F, G, H, I, J) Stage 15 cases. The operation time, intraoperative blood loss, postoperative hospital stay, complications, laparotomy, and lymph node dissection were compared between the two groups. Results: All the patients in different groups were comparable in terms of age, sex, pathological stage and operation method. In group A, the operation time and amount of bleeding in stage C and D were significantly less than those in stage A and B, and the operation time and amount of bleeding in stage I and J were less than those in stage E, F, G and H respectively , Complications, postoperative hospital days and transit to laparotomy rate difference was not statistically significant. In group A, the operation time was significantly less than that in group B, and the amount of bleeding in group A was significantly less than that in group B. The difference between the two groups was statistically significant. The numbers of lymph node dissection, Abdominal rate, surgical complications were not statistically different. Conclusion: When the frequency of surgery is appropriately increased, laparoscopic radical gastrectomy can be better mastered with a shorter learning curve.