外科理论与实践2015，Vol.20Issue(6)：485-489,5.DOI:10.16139/j.1007-9610.2015.06.008
腹腔镜胰十二指肠切除术的学习曲线
Analysis of learning curve for laparoscopic pancreaticoduodenectomy
摘要
Abstract
Objective To analyze the clinical outcomes of different period of learning curve of the laparoscopic pan-creaticoduodenectomy ( LPD ) to improve technique aspects of the procedure . Methods The data of 120 patients who underwent LPD at our institutions between September 2012 and July 2015 were reviewed retrospectively. There were 111 patients who underwent totally LPD and 9 patients underwent laparoscopic assisted pancreaticoduodenectomy. All the patients were divided into 4 groups in order with each 30 patients (1st-30th), (31st-60th), (61st-90th) and (91st-120th) in group A, B, C and D respectively. The overall clinical outcomes and changes during different learning period were ana-lyzed. Results The mean operative time was (359.8±57.6) min and mean blood loss (169.7±152.6) mL. Forty-two (35.0%) cases suffered postoperative complications without mortality. The average length of hospital stay (LOS) was (17.0 ±9.8) d. With accumulating experience of the surgery, the mean operative time tended to decrease from (370.2±52.8) min in group A to (342.0±73.1) min in group D. Moreover, mean operative time of pancreatojejunostomy and choledochojejunostomy also tended to decrease from (55.0±8.7) min, (39.8±11.7) min in group A to (43.6±7.6) min, (27.7±11.8) min in group D respectively. Meanwhile, the clinical results tended to get better with lower mean blood loss, less morbidity and shorter LOS 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 re-spectively except for group D. Conclusions The LPD procedure is feasible and safe in technically developed center and could be routine practice. Clinical outcomes would be improved with accumulating experience after 30 cases of opera-tions, which represents the overcoming of learning curve.关键词
腹腔镜/胰十二指肠切除术/学习曲线Key words
Laparoscopy/Pancreaticoduodenectomy/Learning curve分类
医药卫生引用本文复制引用
鲁超,金巍巍,牟一平,徐晓武,张人超,周育成,严加费,周家瑜,陈荣高..腹腔镜胰十二指肠切除术的学习曲线[J].外科理论与实践,2015,20(6):485-489,5.基金项目
浙江省医学重点学科基金(CX-11-21) （CX-11-21）
浙江省医药卫生平台计划(2015DTA010) （2015DTA010）
