摘要
目的 总结机器人辅助腹腔镜下根治性前列腺切除术的学习曲线.方法 回顾性分析2012年3月至2015年8月3位手术经验背景不同的术者实施的350例机器人辅助腹腔镜下根治性前列腺切除术患者的资料.患者年龄48～87岁,平均67岁.术前PSA 0.308～214ng/ml,中位PSA 12ng/ml.术前肿瘤临床分期T1aN0M0～T3bN1M0期,其中≤T1c期74例,T2a期119例,T2b期63例,T2c期68例,≥T3a期26例.以手术时间、术中出血量及术后住院天数作为学习曲线的衡量指标.结果 手术时间120 ～ 555min,平均220.5min.术中出血量20～1300ml,平均216.3ml,术中输血5例.患者术后住院时间4～ 32d,平均9.3d.随着手术例数的增加,手术时间明显缩短（P＜0.01）,术中出血明显减少（P＜0.01）,患者术后住院时间明显缩短（P＜0.01）.3位术者均成功度过第1个学习曲线,其中1位术者进入第2个学习曲线平台期.结论 机器人辅助腹腔镜下根治性前列腺切除术的学习曲线呈现双平台模式,而术者在学习该术式前的外科背景会影响对该术式的学习.
Objective To study the learning curve of robotic-assisted laparoscopic radical prostatectomy （RALP）.Methods In total, 350 consecutive patients underwent RALP from March 2012 to August 2015, performed by three surgeons with different background of surgical experiences, were included in the study.The mean age of the patients was 67 years （range 48 to 87 years）, median pretreatment serum PSA level was 12 ng/ml （range 0.308 to 214 ng/ml）.Clinical stages were between T1aN0M0 ～ T3bN1 M0 and T3bN1 M0, in which 74 cases staged ≤ T1c, 119 cases staged T2a, 63 staged T2b, 68 staged T2c, and 26 staged ≥T3a cases.Operative time, intraoperative blood loss, and length of postoperative stay were collected for the major parameters of learning curve analyses.Results The mean operative time （include preoperative set up time of the robotic surgical system） was 220.5 min （range 120 to 555 min）.Intraoperative blood loss averaged 216.3 ml （range 20 to 1300 ml）, with blood transfusion performed in 5 cases.Postoperative hospital stay was 9.3 days （range 4 to 32 days）.With accumulation of surgical experience throughout the learning curve, significant improvements were observed regarding operative time （P 〈 0.01）, intraoperative blood loss （P 〈 0.01）, and postoperative hospital stay （P 〈 0.01）.All 3 surgeons had successfully passed the first learning curve, while surgeon 1 reached the second plateau of the learning curve.Conclusions There is a two-plateau learning curve in the study process of RALP.The surgical background of surgeons might have influence on the length of the learning curve.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2016年第4期284-288,共5页
Chinese Journal of Urology
