纯腹腔镜供体右半肝切除术的学习曲线：累积和分析。
The learning curve in pure laparoscopic donor right hepatectomy: a cumulative sum analysis.
机构信息
Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Republic of Korea.
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
出版信息
Surg Endosc. 2019 Nov;33(11):3741-3748. doi: 10.1007/s00464-019-06668-3. Epub 2019 Feb 15.
BACKGROUND
Although the use of pure laparoscopic donor hepatectomy (PLDH) is increasingly common, it remains limited to a few experienced centers and no data on the learning curve are currently available. The aim of this study is to evaluate the learning curve associated with the use of pure laparoscopic donor right hepatectomy (PLDRH).
METHODS
Data from donors undergoing PLDRH performed by a single surgeon between November 2015 and October 2017 were retrospectively reviewed. The learning curve was evaluated using the cumulative sum (CUSUM) method based on duration of surgery.
RESULTS
Of 100 donors evaluated, none required transfusion or conversion to open hepatectomy and no irreversible disability or mortality was reported. The mean operative time was 320.7 ± 51.8 min, and all grafts were successfully transplanted. The CUSUM analysis demonstrated a learning curve of approximately 60 cases of PLDRH. Estimated total liver volume > 1400 cm and double portal vein orifices were seen to be risk factors for longer surgery time. Having adjusted for case mix with these factors, the risk-adjusted CUSUM analysis demonstrated a learning curve of 65-70 cases of PLDRH.
CONCLUSIONS
In conclusion, PLDRH is a feasible and safe procedure with a learning curve of 65-70 cases.
背景
尽管纯腹腔镜供肝切除术（PLDH）的应用越来越普遍，但它仍然局限于少数有经验的中心，目前尚无关于学习曲线的数据。本研究旨在评估使用纯腹腔镜右供肝切除术（PLDRH）相关的学习曲线。
方法
回顾性分析 2015 年 11 月至 2017 年 10 月期间由一位外科医生进行的 PLDRH 供者的数据。使用基于手术时间的累积和（CUSUM）方法评估学习曲线。
结果
在 100 名受评估的供者中，无输血或转为开腹肝切除术的需求，也没有不可逆的残疾或死亡报告。平均手术时间为 320.7±51.8 分钟，所有移植物均成功移植。CUSUM 分析显示，PLDRH 的学习曲线约为 60 例。估计总肝体积>1400cm 和双门静脉口被认为是手术时间延长的危险因素。在调整了这些因素的病例组合后，风险调整后的 CUSUM 分析显示，PLDRH 的学习曲线为 65-70 例。
结论
总之，PLDRH 是一种可行且安全的手术，其学习曲线为 65-70 例。
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