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目的探讨具有丰富开放手术经验的外科医师(>200例次/年)尽快掌握腹腔镜直肠癌根治术的方法。方法回顾性分析2009年8月至2015年4月第二军医大学附属长海医院肛肠外科同一团队完成的120例腹腔镜辅助直肠癌根治术病例资料。按手术日期先后分为A、B、C 3组,每组40例,时间跨度分别为36、19、11个月。比较各组的手术时间、术中出血量、中转开放发生率、清扫淋巴结数、直肠系膜完整性、术后通气时间、术后住院时间及术后并发症发生率,并应用移动平均法绘制手术时间曲线。结果 A组手术时间明显长于B、C组[(162.9±36.7)min vs.(147.0±36.8)min vs.(132.7±31.9)min,P<0.05],B、C组间差异无统计学意义(P>0.05);A组在术中出血量、中转开放发生率和术后住院时间方面与B、C组差异无统计学意义(P>0.05);其余指标包括淋巴结清扫数、直肠标本系膜完整性、术后通气时间和术后并发症发生率,3组差异均无统计学意义(P>0.05)。手术时间曲线显示,在手术开展至41~51例后,手术时间逐渐稳定。结论具有丰富开放手术经验的外科医师腹腔镜直肠癌根治术的学习曲线约为40例。
Objective To investigate the method of mastectomy for radical resection of laparoscopic rectal cancer as soon as possible by a surgeon with rich experience in open surgery (> 200 cases / year). Methods A retrospective analysis of 120 cases of laparoscopic radical resection of rectal cancer performed by the same team in Changhai Hospital affiliated to Second Military Medical University from August 2009 to April 2015 was performed. According to the operation date, the patients were divided into A, B and C groups, 40 cases in each group. The time span was 36, 19 and 11 months respectively. The operation time, intraoperative blood loss, the incidence of transit openning, the number of lymph nodes dissected, the integrity of the mesorectal membrane, postoperative ventilation, postoperative hospital stay and postoperative complications were compared. Time curve. Results The operation time of group A was significantly longer than that of group B and C [(162.9 ± 36.7) min vs (147.0 ± 36.8) min vs. (132.7 ± 31.9) min, P <0.05], but there was no significant difference between group B and C (P> 0.05). There was no significant difference between group A and group B and group C in the amount of bleeding during operation, the incidence of transit and postoperative hospital stay (P> 0.05). The remaining indexes included the number of lymph node dissection and rectal specimen Membrane integrity, postoperative ventilation and postoperative complications, the three groups showed no significant difference (P> 0.05). Surgery time curve showed that in 41 to 51 cases of surgery, the operation time gradually stabilized. Conclusions There are about 40 learning curves for surgeons with laparoscopic radical resection of rectal cancer who have extensive experience in open surgery.