Melendez T D, Childers J M, Nour M, Harrigill K, Surwit E A
JSLS. 1997 Jan-Mar;1(1):45-9.
To evaluate our learning-curve experience with laparoscopic management of endometrial carcinoma.
Retrospective review of our first 125 patients with endometrial cancer who were managed laparoscopically. The patient population was reviewed in a chronological manner, noting patient demographics, operative procedure and times, estimated blood loss, hospital stay, complications, and pathology.
Overall, the mean age was 68.6 years (range 29-89), the mean weight was 160 pounds (range 97-328), and the mean Quetelet index was 27.8 (range 17.8-56.4). Metastatic disease was discovered in 28.8% (17/59) of patients with grade 2 or 3 lesions. There was no statistically significant variation in any of these parameters throughout the study. Operative times for staging without lymphadenectomy decreased significantly from a mean of 163 minutes to 99 minutes (p < .001). Operative times for staging with lymphadenectomy decreased from a mean of 196 minutes to 128 minutes (p < 0.02). Hospital stay decreased from a mean of 3.2 days in the first quarter of our study to 1.8 days (p < .0001). The overall average complication rate of 4% (two enterotomies, two cystotomies, and a transected ureter) did not vary. However, the rate of conversion to laparotomy dropped significantly from 8% (2/25) to 0% (0/100).
We found that operative times and hospital stays for laparoscopic staging of endometrial cancer continued to drop after 125 cases. While the ability to detect metastatic disease and the rate of major complications appear unrelated to length of the operator experience, the conversion rate to laparotomy decreases with operator experience. Learning-curve parameters must be recognized by physicians, patients, and researchers for a host of reasons.
评估我们在腹腔镜治疗子宫内膜癌方面的学习曲线经验。
回顾性分析我们首批125例接受腹腔镜治疗的子宫内膜癌患者。按时间顺序对患者群体进行分析，记录患者人口统计学资料、手术操作及时间、估计失血量、住院时间、并发症及病理情况。
总体而言，平均年龄为68.6岁（范围29 - 89岁），平均体重为160磅（范围97 - 328磅），平均体重指数为27.8（范围17.8 - 56.4）。在2级或3级病变的患者中，28.8%（17/59）发现有转移疾病。在整个研究过程中，这些参数均无统计学上的显著差异。未行淋巴结清扫的分期手术时间从平均163分钟显著降至99分钟（p < 0.001）。行淋巴结清扫的分期手术时间从平均196分钟降至128分钟（p < 0.02）。住院时间从我们研究第一季度的平均3.2天降至1.8天（p < 0.0001）。总体平均并发症发生率为4%（2例肠切开、2例膀胱切开和1例输尿管横断），无变化。然而，转为开腹手术的比例从8%（2/25）显著降至0%（0/100）。
我们发现，在125例病例之后，腹腔镜分期治疗子宫内膜癌的手术时间和住院时间持续下降。虽然检测转移疾病的能力和主要并发症发生率似乎与术者经验时长无关，但转为开腹手术的比例随术者经验而降低。出于诸多原因，医生、患者和研究人员都必须认识到学习曲线参数。
