[1]高永山** 张志杰① 付伟 张振明 董跃华 王大伟 杨燕君 姜伟华.单操作孔胸腔镜肺叶切除术治疗非小细胞肺癌的学习曲线[J].中国微创外科杂志,2020,01(11):972-976.
　Gao Yongshan*,Zhang Zhijie,Fu Wei*,et al.Learning Curve of Single Utility Port Videoassisted Thoracoscopic Surgery Lobectomy for Patients With Nonsmall Cell Lung Cancer[J].Chinese Journal of Minimally Invasive Surgery,2020,01(11):972-976.
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单操作孔胸腔镜肺叶切除术治疗非小细胞肺癌的学习曲线()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年11期
页码:
972-976
栏目:
临床论著
出版日期:
2020-11-25

文章信息/Info

Title:
Learning Curve of Single Utility Port Videoassisted Thoracoscopic Surgery Lobectomy for Patients With Nonsmall Cell Lung Cancer
作者:
高永山** 张志杰① 付伟 张振明 董跃华 王大伟 杨燕君 姜伟华
(河北北方学院附属第一医院胸心外科，张家口075000)
Author(s):
Gao Yongshan*;  Zhang Zhijie;  Fu Wei*;  et al.
*Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
关键词:
非小细胞肺癌; 单操作孔; 电视胸腔镜手术; 肺叶切除术; 学习曲线; CUSUM分析
Keywords:
Nonsmall cell lung cancer; Single utility port;  Videoassisted thoracoscopic surgery; Lobectomy; Learning curve; CUSUM analysis
文献标志码:
A
摘要:
目的探讨单操作孔胸腔镜肺叶切除术治疗非小细胞肺癌的学习曲线。方法回顾性分析2012年8月~2016年12月同一手术团队连续完成的单操作孔胸腔镜肺叶切除术治疗非小细胞肺癌120例资料，使用累积和(cumulative sum，CUSUM)方法分析其学习曲线，并对学习曲线不同阶段的手术时间、术中出血量、淋巴结清扫组数及个数、术后住院时间、中转开胸率、术后并发症发生率等进行比较。结果CUSUM学习曲线最佳拟合方程为y=-9.225+2.833x-0.01932x2-0.00003698x3，拟合优度R2=0.9475，拟合曲线在手术例数累积至第62例以后斜率变为负，以此为界将学习曲线划分为2个阶段，A阶段为学习提高阶段(n=62)，B阶段为熟练掌握阶段(n=58)。B阶段手术时间、术中出血量、术后住院时间、中转开胸率及术后并发症发生率均优于A阶段(P<0.05)，2个阶段淋巴结清扫组数、个数以及累积生存率差异均无显著性(P>005)。结论在地市级三甲医院条件下，开展单操作孔胸腔镜肺叶切除术治疗非小细胞肺癌的学习曲线为62例，时间跨度2年半。
Abstract:
ObjectiveTo explore the learning curve of single utility port videoassisted thoracoscopic surgery (VATS) lobectomy for patients with nonsmall cell lung cancer (NSCLC).MethodsWe retrospectively analyzed the clinical data of 120 consecutive patients with NSCLC who underwent single utility port complete VATS lobectomy by the same team from August 2012 to December 2016. The cumulative sum analysis (CUSUM) was used to study the learning curve of single utility port VATS lobectomy. The operating time, blood loss, number of dissected lymph nodes and nodal stations, postoperative hospital stay, rate of thoracotomy conversion and postoperative complications were compared. ResultsThe CUSUM learning curve were best modeled as a polynomial with equation: y=-9.225+2.833x-0.01932x2-0.00003698x3, with goodnessoffit test R2=0.9475. The fitting curve slope turned into negative at the 62nd case, and the learning curve were divided into learning stage (stage A, n=62) and mastery stage (stage B, n=58) with 62 cases as the cut off point. The operative time, blood loss, postoperative hospital stay, rate of thoracotomy conversion and postoperative complications in stage B was significantly better than that in stage A (all P<0.05). The two stages were similar in terms of the number of dissected lymph nodes and nodal stations, and cumulative overall survival rates (all P>0.05).ConclusionLearning curve of single utility port VATS lobectomy for patients with NSCLC is approximately 62 cases and the time span of 2.5 years in municipal hospitals.

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备注/Memo

备注/Memo:
基金项目：张家口市科技局指导项目(1921033D)**通讯作者，Email：gaoyongshan3333@163.com ①(中国人民解放军陆军第八十一集团军医院放射科，张家口075000)
更新日期/Last Update: 2021-02-07