肝细胞癌和肝内胆管细胞癌患者行开腹肝肿瘤切除术的学习曲线的回顾性单中心研究。
A Retrospective, Single-Centre Study on the Learning Curve for Liver Tumor Open Resection in Patients with Hepatocellular Cancers and Intrahepatic Cholagangiocarcinomas.
机构信息
First Department of Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland.
Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland.
出版信息
Int J Environ Res Public Health. 2022 Apr 17;19(8):4872. doi: 10.3390/ijerph19084872.
BACKGROUND
Liver resections have become the first-line treatment for primary malignant tumors and, therefore, are considered a core aspect of surgical training. This study aims to evaluate the learning curve for the safety of open hemihepatectomy procedures for patients suffering from hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC).
METHODS
This single tertiary center retrospective analysis includes 81 consecutive cases of right or left hemihepatectmy. A cumulative sum (CUSUM) control chart was used to investigate the learning curve.
RESULTS
The CUSUM curve for operative time and blood loss level peaked at the 29th and 30th case, respectively. The CUSUM curve for minor adverse effects (mAEs) and severe adverse effects (sAEs) showed a downward slope after the 27th and 36th procedures; the curve, however, remained within the acceptable range throughout the entire study.
CONCLUSION
When performing open hemihepatectomies in patients with HCC and ICC, the stabilization of the operative time and intraoperative blood loss level are gained earlier than sAEs risk reduction.
背景
肝切除术已成为原发性恶性肿瘤的首选治疗方法，因此被认为是外科培训的核心内容。本研究旨在评估开腹半肝切除术治疗肝细胞癌（HCC）或肝内胆管细胞癌（ICC）患者的安全性学习曲线。
方法
这是一项单中心回顾性分析，共纳入 81 例连续接受右半或左半肝切除术的患者。采用累积和（CUSUM）控制图来研究学习曲线。
结果
手术时间和出血量的 CUSUM 曲线在第 29 例和第 30 例时达到峰值。轻微不良事件（mAEs）和严重不良事件（sAEs）的 CUSUM 曲线在第 27 例和第 36 例后呈下降趋势，但整个研究过程中曲线均在可接受范围内。
结论
在 HCC 和 ICC 患者中施行开腹半肝切除术时，手术时间和术中出血量稳定的获得早于严重不良事件风险的降低。
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