Lu Chao, Jin Weiwei, Mou Yi-Ping, Zhou Jiayu, Xu Xiaowu, Xia Tao, Zhang Renchao, Zhou Yucheng, Yan Jiafei, Huang Chaojie, Zhang Bin, Wang Jingrui
Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310058, China.
J Vis Surg. 2016 Aug 18;2:145. doi: 10.21037/jovs.2016.07.25. eCollection 2016.
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) may have potential minimal invasive advantages for selected patients in limited center. However, few studies analyzed the learning curve. This study aimed to analyze the learning curve of this procedure at a large volume set, and share our experience to surmount it. METHODS: All prospectively maintained data of the consecutive LPDs was reviewed retrospectively. The procedures were performed by single surgeon. Patients were divided into four groups according to staged approach with different focuses: Group A (the first 30 patients), Group B (the second 30 patients), Group C (the third 30 patients), and Group D (the fourth and last 30 patients). And the changes of outcomes during different learning periods were analyzed. RESULTS: Between September 2012 and July 2015, 120 patients underwent LPD. One hundred and eleven of them underwent totally LPD, and 9 patients underwent laparoscopic assisted pancreaticoduodenectomy (LAPD). The mean operative time (OT), mean blood loss and average length of hospital stay (LOS) was 359.8±57.6 min, 169.7±152.6 mL and 17.0±9.8 d respectively. A total of 42 (35%) patients developed morbidity with no mortality. The mean overall OT tended to decrease from 370.2±52.8 min in Group A to 342.0±73.1 min in Group D with the accumulating experience of the surgeon. Moreover, mean OT of pancreatojejunostomy and choledochojejunostomy also tended to decrease from 55.0±8.7, 39.8±11.7 min in Group A to 43.6±7.6, 27.7±11.8 min in Group D respectively. Meanwhile, the clinical outcomes tended to get better. Mean blood loss, morbidity and LOS decreased from 219.3±147.9 mL, 43.3%, 18.7±10.0 d in Group A to 140.1±73.6 mL, 23.3%, 14.4±6.2 d in Group C respectively except for Group D. CONCLUSIONS: Routine practice of the LPD procedure was feasible and safe. Gained experience can improve clinical outcomes in 30 to 60 operations by overcoming the learning curve.
背景:对于特定患者,在有限的医疗中心开展腹腔镜胰十二指肠切除术(LPD)可能具有潜在的微创优势。然而,很少有研究分析其学习曲线。本研究旨在分析在大量病例中该手术的学习曲线,并分享我们克服学习曲线的经验。 方法:回顾性分析所有连续LPD手术的前瞻性维护数据。手术由单一外科医生进行。根据不同阶段将患者分为四组:A组(前30例患者)、B组(接下来的30例患者)、C组(再接下来的30例患者)和D组(最后30例患者)。分析不同学习阶段手术结果的变化。 结果:2012年9月至2015年7月期间,120例患者接受了LPD手术。其中111例行完全LPD,9例行腹腔镜辅助胰十二指肠切除术(LAPD)。平均手术时间(OT)、平均失血量和平均住院时间(LOS)分别为359.8±57.6分钟、169.7±152.6毫升和17.0±9.8天。共有42例(35%)患者发生并发症,无死亡病例。随着外科医生经验的积累,总体平均OT倾向于从A组的370.2±52.8分钟降至D组的342.0±73.1分钟。此外,胰肠吻合术和胆肠吻合术的平均OT也倾向于分别从A组的55.0±8.7、39.8±11.7分钟降至D组的43.6±7.6、27.7±11.8分钟。同时,临床结果趋于改善。除D组外,平均失血量、并发症发生率和住院时间分别从A组的219.3±147.9毫升、43.3%、18.7±10.0天降至C组的140.1±73.6毫升、23.3%、14.4±6.2天。 结论:LPD手术的常规开展是可行且安全的。通过克服学习曲线,在30至60例手术中积累的经验可改善临床结果。
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