[1]刘岩 高新宝 王明玲 李浩 贾高磊**.无充气腋窝入路腔镜甲状腺系膜切除术的学习曲线[J].中国微创外科杂志,2024,01(2):81-85.
　Liu Yan,Gao Xinbao,Wang Mingling,et al.Learning Curve of Endoscopic Mesothyroid Excision via Gasless Axillary Approach[J].Chinese Journal of Minimally Invasive Surgery,2024,01(2):81-85.
点击复制

无充气腋窝入路腔镜甲状腺系膜切除术的学习曲线()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年2期
页码:
81-85
栏目:
临床论著
出版日期:
2024-02-25

文章信息/Info

Title:
Learning Curve of Endoscopic Mesothyroid Excision via Gasless Axillary Approach
作者:
刘岩 高新宝 王明玲 李浩 贾高磊**
(徐州市中心医院徐州医科大学徐州临床学院血甲疝微创外科，徐州221009)
Author(s):
Liu Yan;  Gao Xinbao;  Wang Mingling;  et al.
Department of Vascular Thyroid Hernia Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou 221009, China
关键词:
腋窝入路; 内镜; 甲状腺系膜切除术; 学习曲线
Keywords:
Axillary approach; Laparoscopy; Mesothyroid excision; Learning curve
文献标志码:
A
摘要:
目的探讨无充气腋窝入路腔镜甲状腺系膜切除术的学习曲线。方法回顾性分析由同一手术团队2020年5月~2022年12月行无充气腋窝入路腔镜甲状腺系膜切除术44例资料。以手术时间为指标，应用累积和分析法研究该手术的学习曲线，将学习曲线的拐点作为学习提高期和成熟稳定期的分界线，比较2个阶段患者的一般资料、手术时间、术中出血量、住院时间、淋巴结清扫数目、术后并发症的差异。结果44例均顺利完成手术，无中转开放手术。学习曲线拐点在21例，以此为界分为学习提高期和成熟稳定期。两阶段一般资料无统计学意义(P>0.05)；学习提高期的手术时间显著长于成熟稳定期［(124.5±9.9) min vs. (82.0±8.8) min，t=15.166，P=0.000］，术后胸锁乳突肌肿胀僵硬发生率高，但差异无统计学意义［6例(28.6%) vs. 1例(4.3%), χ2=3.174，P=0.075］；2个阶段术中出血量、住院时间、淋巴结清扫数目、术后其他并发症等方面差异无统计学意义(均P>0.05)。结论熟练掌握无充气腋窝入路腔镜甲状腺系膜切除术需要完成21例。
Abstract:
ObjectiveTo explore the learning curve of endoscopic mesothyroid excision via gasless axillary approach.MethodsClinical data of 44 patients who underwent endoscopic mesothyroid excision via gasless axillary approach between May 2020 and December 2022 by the same surgical team were retrospectively analyzed. Taking operation time as index, the learning curve of the operation was studied with the cumulative sum method (CUSUM). The cutoff value of the learning curve was regarded as the dividing line of different stages. The general data, operation time, intraoperative blood loss, hospital stay, number of lymph node dissection, and postoperative complications were compared between the different phases of the learning curve.ResultsThe operations were successfully completed in all the 44 patients without conversion to open surgery. The cumulative sum fitting curve reached the top at the 21st case, which was used as the boundary to divide the learning curve into learning improvement stage and mature stable period. There was no statistically significant difference between the two stages in general data (P>0.05). The operation time in the learning improvement stage was significantly longer than in the mature stable period ［(124.5±9.9) min vs. (82.0±8.8) min, t=15.166, P=0.000］. The incidence of postoperative sternocleidomastoid muscle swelling and stiffness in patients in the learning improvement stage was higher than that in the mature stable period, but the difference was not statistically significant ［6 cases (28.6%) vs. 1 case (43%), χ2=3.174, P=0.075］. There was no significant difference between the two groups in terms of intraoperative bleeding, hospital stay, number of lymph node dissection, and other postoperative complications (all P>0.05).ConclusionTo proficiently master the endoscopic mesothyroid excision via the gasless axillary approach, 21 cases need to be completed.

参考文献/References:

[1]Lim H,Devesa SS,Sosa JA,et al.Trends in thyroid cancer incidence and mortality in the United States,1974-2013.JAMA,2017,317(13):1338-1348.
[2]王平,项承.经胸前入路腔镜甲状腺手术专家共识(2017版).中国实用外科杂志,2017,37(12):1369-1373.
[3]王平,吴国洋,田文,等.经口腔前庭入路腔镜甲状腺手术专家共识(2018版).中国实用外科杂志,2018,38(10):1104-1107.
[4]中国抗癌协会甲状腺癌专业委员会,中华医学会肿瘤学分会甲状腺肿瘤专业委员会,中国研究型医院学会甲状腺疾病专业委员会,等.无充气腋窝入路腔镜甲状腺手术专家共识(2022版).中华内分泌外科杂志,2021,15(6): 557-563.
[5]Chung YS,Choe JH,Kang KH,et al.Endoscopic thyroidectomy for thyroid malignancies:comparison with conventional open thyroidectomy.World J Surg,2007,31(12):2302-2308.
[6]郑传铭,毛晓春,王佳峰,等.无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会.中国肿瘤临床,2018,45(1):27-32.
[7]Lei S,Ding Z,Ge J,et al.Anatomy of mesothyroid:value of mesothyroid excision in thyroid cancer patients.Hepatogastroenterology,2014,61(136):2181-2184.
[8]雷尚通.甲状腺系膜切除术——基于解剖层面的手术技术.临床外科杂志,2017,25(11):823-825.
[9]葛军娜,魏志刚,孙百慧,等.无充气腋窝入路内镜甲状腺系膜切除术.中国实用外科杂志,2021,41(12):1434-1436.
[10]中华医学会内分泌学会,中华医学会外科学甲状腺及代谢外科学组,中国抗癌协会头颈专业委员会.甲状腺结节和分化型甲状腺癌诊治指南(第二版).中华内分泌代谢杂志,2023,39(3):181-226.
[11]高永山,张志杰,付伟,等.单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌的学习曲线.中国微创外科杂志,2021,21(12):1072-1076.
[12]黄海,陈欣欣,马宇园,等.无充气腋窝入路完全腔镜下甲状腺癌根治术的学习曲线分析.中国普通外科杂志,2021,30(5):522-530.
[13]Kandil E,Hammad AY,Walvekar RR,et al.Robotic thyroidectomy versus nonrobotic approaches: a metaanalysis examining surgical outcomes.Surg Innov,2016,23(3):317-325.
[14]王佳峰,徐加杰,蒋烈浩,等.无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部功能影响的初步研究.中华内分泌外科杂志,2021,15(1):10-14.
[15]Lee DW,Ko SH,Song CM,et al.Comparison of postoperative cosmesis in transaxillary,postauricular facelift,and conventional transcervical thyroidectomy.Surg Endosc,2020,34(8):3388-3397.
[16]章德广,何高飞,李建波,等.改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌70例疗效分析.中国实用外科杂志,2022,42(6):691-694,699.
[17]Kudsi OY,Gokcal F,BouAyash N,et al.Learning curve in robotic transabdominal preperitoneal (rTAPP) ventral hernia repair:a cumulative sum (CUSUM) analysis.Hernia,2021,25(3):755-764.
[18]徐加杰,张李卓,张启弘,等.无充气经腋窝腔镜甲状腺手术的临床应用.中华耳鼻咽喉头颈外科杂志,2020,55(10):913-920.
[19]陈俊勇,邵子力,韩梦玲,等.经腋窝入路免充气腔镜甲状腺单侧腺叶切除术的学习曲线.腹腔镜外科杂志,2022,27(9):667-671.
[20]贾高磊,田志龙,耿厚法,等.无充气腋窝入路完全腔镜下甲状腺手术意外出血的处理.中国微创外科杂志,2022,22(7):570-574.
[21]刘岩,田志龙,高新宝,等.无充气经腋窝后入路腔镜甲状腺癌手术效果评价.中国普外基础与临床杂志,2022,29(11):1463-1467.
[22]刘岩,田志龙,高新宝,等.无充气经腋窝后入路腔镜甲状腺微灶癌手术47例.中国微创外科杂志,2022,22(10):803-807.

备注/Memo

备注/Memo:
基金项目：徐州市科技计划项目(KC22156)；徐州医科大学附属医院科技发展面上项目(XYFM202204)**通讯作者，Email：zxyyjgl@163.com
更新日期/Last Update: 2024-05-03