Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Int J Colorectal Dis. 2012 Apr;27(4):527-33. doi: 10.1007/s00384-011-1358-6. Epub 2011 Nov 30.
This study aimed to evaluate the learning curve for laparoscopic colorectal resection of a university colorectal unit, the operative outcome in its developing and established period of laparoscopic colorectal resection is compared.
We analyzed 1,031 consecutive patients who underwent laparoscopic colorectal resections for colorectal carcinoma performed in a colorectal unit between April 1992 and December 2008. Multi-dimensional analyses of the learning curves of the institution and seven individual surgeons were performed.
The operative outcomes of period 2 (2002-2008) was generally better than period 1 (1992-2001), in terms of operative time, number of lymph nodes retrieved, intra-operative blood loss and transfusion. The conversion rate of period 1 was higher than period 2 (19.7% vs. 5.1%, p < 0.001). There were no difference in the rates of intra-operative complications (2% vs. 3.3%, p = 0.32) and major post-operative complications (6% vs. 4.5%, p = 0.28). Analysis of the operative time using moving average method showed that the operative time of period 2 was generally shorter than that of period 1. The operative time transiently increased when there were new trainee surgeons joining the program. The CUSUM analysis of institutional conversion rate showed a steady state being reached at 310 cases. For the rates of intra-operative and major post-operative complications, steady states were both achieved at around 50 cases, and these rates were maintained during the whole study period.
Operative outcome of laparoscopic colorectal resection improved with experience. Continuous training of new trainee would not affect the operative outcomes of an established specialized unit.
本研究旨在评估一所大学结直肠外科腹腔镜结直肠切除术的学习曲线，并比较其在发展和确立腹腔镜结直肠切除术阶段的手术结果。
我们分析了 1992 年 4 月至 2008 年 12 月期间在一个结直肠外科治疗中心接受腹腔镜结直肠切除术治疗结直肠癌的 1031 例连续患者。对机构和 7 名个体外科医生的学习曲线进行了多维分析。
第 2 阶段（2002-2008 年）的手术结果总体优于第 1 阶段（1992-2001 年），表现在手术时间、淋巴结检出数、术中出血量和输血方面。第 1 阶段的转化率高于第 2 阶段（19.7%比 5.1%，p<0.001）。术中并发症发生率（2%比 3.3%，p=0.32）和主要术后并发症发生率（6%比 4.5%，p=0.28）无差异。使用移动平均法分析手术时间显示，第 2 阶段的手术时间普遍短于第 1 阶段。当有新的受训外科医生加入该计划时，手术时间会暂时增加。机构转化率的 CUSUM 分析显示，在 310 例时达到稳定状态。对于术中并发症和主要术后并发症发生率，在大约 50 例时达到稳定状态，并且在整个研究期间这些发生率保持不变。
腹腔镜结直肠切除术的手术结果随经验的积累而改善。不断培训新的受训外科医生不会影响成熟专业治疗中心的手术结果。
