胸,腹腔镜食管癌切除术学习曲线分析.docVIP

胸腹腔镜食管癌切除术学习曲线分析 陈焕文，杜 铭，吴庆琛，王显平，唐文风，赖光湖 （400016 重庆，重庆医科大学附属第一医院心胸外科） [摘要] 目的 探讨胸腹腔镜食管癌切除术学习曲线。方法 分析2009年9月至2010年12月由作者本人完成的38例胸腹腔镜食管癌切除术。按手术先后次序分4组(A、B、C、D)，每组约10例，比较各组手术时间、术中出血量、淋巴结清扫总数、中转开胸率、并发症。结果 各组手术时间术中出血量虽然有下降趋势，但是没有统计学意义(P0.05)。无中转开腹，中转开胸率、淋巴结清扫个数，术后并发症率差异没有显著意义。而前两组（A组+B组）手术时间、术中出血量和后两组（C组+D组）手术时间、术中出血量有统计学差异(P均0.05)。结论 有成熟模式引导，具备一定胸腔镜其他手术操作经验的无胸腹腔食管癌切除经验医师完成胸腹腔镜食管癌切除术的学习曲线大约为20例。 [关键词] 学习曲线；胸腔镜;腹腔镜 [中图法分类号] [文献标志码] A The learning curve of Esophagectomy With thoracoscopy and laparoscopy for esophageal carcinoma Chen Huanwen, Du Ming,Wu Qingchen,Wang Xianpin,Tang Wenfeng,Lai Guanghu(Department of Thoracic and Cardiovascular Surgery,First Affiliated Hospital Chongqing Medical University,Chongqing 400011, China) [Abstract] Objective To analyze the learning curve of Esophagectomy With thoracoscopy and laparoscopy for esophageal carcinoma .Methods From September 2009 to december 2010，38 Cases of Esophagectomy With thoracoscopy and laparoscopy for esophageal carcinoma .were performed by one surgeons．Clinical data were collected prospectively and analyzed retrospectively．the patients operated were divided into 4groups operating time，blood loss，number of resected lymph nodes，rate of thoraeotomy conversion and postoperative complications were compared．Results The operating time of groups and blood loss was gradually decreased，but there were no significant differences in operating time，blood loss，number of resected lymph nodes，rate of thoraeotomy conversion and postoperative complications(P0．05)．And in groups，there was a significant reduction of blood loss for the last 18 cases comparedthe first 20 cages(P 0．05)．Conclusions The learning curve of Esophagectomy With thoracoscopy and laparoscopy for esophageal carcinoma is approximately 20 cases. [Key words] thoracoscopy；laparoscopy； learning curve 上个世纪末，胸腔镜在胸外科领域开始运用。随着腔镜技术的逐渐提高，腔镜器械的不断完善，目前电视胸腔镜手术已广泛运用于胸部的各种疾病的诊疗[1-6]。研究表明，胸腹腔镜食管癌切除术能够减轻患者创伤，术中出血量，减少患者术