Zheng Wei, Wu Xin, Zhang Lei, Song Gang, Zhang Zheng, Gong Kan, Song Yi, Li Xue-song, He Zhi-song, Zhou Li-qun
Department of Urology, Peking University First Hospital, Beijing, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2012 Aug 18;44(4):558-62.
To evaluate the changes in perioperative outcomes that might refect progress along the learning curving by a single-surgeon's experience in our institution with laparoscopic radical cystectomy (LRC).
This report was conducted between May 2004 and January 2012 in 60 patients (9 women and 51 men) who underwent LRC for bladder cancer. The mean patient age was (60.8±11.4) years, and mean BMI was (23.9±2.7) kg/m(2). We divided the patients into 3 groups (group A, group B, and group C; each group had twenty patients) by the time, and compared the operative time, intraoperative blood loss, hospital stay among the three groups.
The mean intraoperative blood loss was (799.2±717.8) mL, the mean operative time was (420.2±119.8) minutes, and the mean hospital stay was (15.7±11.0) d; There was no statistically significant difference in age, American Society of Anesthesiologists (ASA) scores and BMI among the three groups (P>0.05). Their operative time was (497.5±131.2), (413.6±75.6) and (349.4±100.2) minutes, respectively, for each group, P<0.001. The intraoperative blood loss was (1 080.0±1 028.8), (862.5±510.6) and (455.5±262.3) mL, for each group, P=0.018. The hospital stay was (20.8±13.5), (16.4±10.6) and (9.8±4.4) d, for each group, P=0.005. However, there was no statistically significant difference in postoperative complications among the three groups.
Our experience of LRC appears to be favorable with reduction in blood loss, operative time and hospital stay with increasing experience. The curving shows a significant decline at 2 different breakpoints: after the first 20 cases, and after 40 cases.
通过单一外科医生在我们机构进行腹腔镜根治性膀胱切除术（LRC）的经验，评估围手术期结果的变化，这些变化可能反映学习曲线的进展。
本报告于2004年5月至2012年1月对60例因膀胱癌接受LRC的患者（9例女性和51例男性）进行。患者平均年龄为（60.8±11.4）岁，平均体重指数为（23.9±2.7）kg/m²。我们根据时间将患者分为3组（A组、B组和C组；每组20例患者），并比较三组之间的手术时间、术中出血量和住院时间。
术中平均出血量为（799.2±717.8）mL，平均手术时间为（420.2±119.8）分钟，平均住院时间为（15.7±11.0）天；三组患者在年龄、美国麻醉医师协会（ASA）评分和体重指数方面无统计学显著差异（P>0.05）。每组的手术时间分别为（497.5±131.2）、（413.6±75.6）和（349.4±100.2）分钟，P<0.001。每组术中出血量分别为（1080.0±1028.8）、（862.5±510.6）和（455.5±262.3）mL，P=0.018。每组住院时间分别为（20.8±13.5）、（16.4±10.6）和（9.8±4.4）天，P=0.005。然而，三组患者术后并发症无统计学显著差异。
我们的LRC经验似乎良好，随着经验增加，出血量、手术时间和住院时间均有所减少。学习曲线在2个不同的转折点出现显著下降：前20例之后，以及40例之后。
