手辅助腹腔镜结肠切除术的学习曲线：一位外科医生的经验
The learning curve for hand-assisted laparoscopic colectomy: a single surgeon's experience.
作者信息
Kang J-C, Jao S-W, Chung M-H, Feng C-C, Chang Y-J
机构信息
Division of Colorectal Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC.
出版信息
Surg Endosc. 2007 Feb;21(2):234-7. doi: 10.1007/s00464-005-0448-3. Epub 2006 Dec 9.
BACKGROUND
Surgical experience and outcomes for hand-assisted laparoscopic colectomy were evaluated to define a learning curve.
METHODS
This study included 60 patients who underwent hand-assisted laparoscopic colectomies performed by a single surgeon. They were analyzed as three consecutive equal groups: A, B, and C. Pearson's chi-square test and one-way analysis of variance (ANOVA) were used to compare differences in demographics and perioperative parameters. Operative times were analyzed to document the learning curve for the procedure.
RESULTS
There were no significant differences between the three groups in terms of age, sex, operative procedure, or comorbidity. Groups B and C showed significantly shorter operative times, significantly earlier recoveries of gastrointestinal function, less blood loss, and shorter hospital stays than group A. The incidence of operative complications was not significantly different among the three groups (35% vs 5% vs 15%; p = 0.07).
CONCLUSIONS
Approximately 21 to 25 cases were needed to achieve proficiency in this series.
背景
对手辅助腹腔镜结肠切除术的手术经验和结果进行评估，以确定学习曲线。
方法
本研究纳入了60例行由单一外科医生实施的手辅助腹腔镜结肠切除术的患者。他们被分为连续的三个均等组：A组、B组和C组。采用Pearson卡方检验和单因素方差分析（ANOVA）比较人口统计学和围手术期参数的差异。分析手术时间以记录该手术的学习曲线。
结果
三组在年龄、性别、手术方式或合并症方面无显著差异。B组和C组的手术时间明显更短，胃肠功能恢复明显更早，失血量更少，住院时间更短，均优于A组。三组手术并发症的发生率无显著差异（35%对5%对15%；p = 0.07）。
结论
在本系列研究中，达到熟练水平大约需要21至25例手术。
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