[1]梁苗 李永康 温宇 王延洲① 戴巧 陈诚**.单中心经脐单孔腹腔镜全子宫切除术的学习曲线分析[J].中国微创外科杂志,2022,01(11):874-878.
　Liang Miao,Li Yongkang,Wen Yu,et al.Learning Curve Analysis of Transumbilical Laparoendoscopic Singlesite Surgery of Total Hysterectomy in One Medical Center[J].Chinese Journal of Minimally Invasive Surgery,2022,01(11):874-878.
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单中心经脐单孔腹腔镜全子宫切除术的学习曲线分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年11期
页码:
874-878
栏目:
临床研究
出版日期:
2023-02-23

文章信息/Info

Title:
Learning Curve Analysis of Transumbilical Laparoendoscopic Singlesite Surgery of Total Hysterectomy in One Medical Center
作者:
梁苗 李永康 温宇 王延洲① 戴巧 陈诚**
(重庆市人民医院妇产科，重庆401147)
Author(s):
Liang Miao;  Li Yongkang;  Wen Yu;  et al.
Department of Gynaecology and Obstetrics, Chongqing General Hospital, Chongqing 401147, China
关键词:
经脐单孔腹腔镜手术; 全子宫切除术; 学习曲线; 累积求和分析法
Keywords:
Transumbilical laparoendoscopic singlesite surgery; Total hysterectomy; Learning curve; Cumulative summation
文献标志码:
A
摘要:
目的探讨单中心采用单孔入路平台完成经脐单孔腹腔镜全子宫切除术的学习曲线。方法回顾性分析我院单一主刀医生2020年5月~2021年8月连续施行66例单孔腹腔镜子宫全切术的临床资料，通过累积求和分析法 (cumulative summation，CUSUM)，计算手术时间(A1)、术中出血量(A2)、术后并发症(A3)的累积求和值，即每个手术的量化值：Σ=A1+A2+A3。以Σ为基础绘制学习曲线并进行多项式曲线拟合：y=6×10-7x4+0.0002x3-0.0384x2+1.4742x+00864，决定系数R2=0.9874，当曲线斜率k自正值转变为负值时，即跨越学习曲线和拟合曲线公式。结果所有患者手术均顺利进行，无中转多孔及开腹手术。手术时间(130.3±40.5)min(85～250 min)；出血量(106.2±82.9)ml(20～400 ml)。对拟合函数y求导y′=2.4×10-6x3+0.0006x2-0.0768x+14742，每例手术的k值对应拟合函数的导数值，25例手术后CUSUM 学习曲线k值为负。结论依据研究获得的学习曲线，有30例以上多孔腹腔镜全子宫切除术经验的医生经过25例经脐单孔腹腔镜全子宫切除术可以跨越学习曲线。
Abstract:
ObjectiveTo investigate the learning curve of transumbilical laparoendoscopic singlesite surgery (TULESS) of total hysterectomy in one medical center.MethodsClinical data of 66 patients who received total hysterectomy from May 2020 to August 2021 in our hospital were retrospectively analyzed. The learning curve of TULESS of total hysterectomy was drawn by using cumulative summation (CUSUM). The cumulative sum of operative time (A1), blood loss (A2) and postoperative complications (A3) was calculated, that was, the quantitative value of each operation:Σ=A1+A2+A3. The learning curve was drawn and the polynomial curve was fitted based on the Σ: y=6×10-7x4+0.0002x3-0.0384x2+1.4742x+00864, the fitting coefficient R2=09874. When the curve slope k changed from a positive value to a negative value, the learning curve and fitting curve formula were inflected. ResultsAll the operations were successfully completed without conversion to multiport or open surgery. The operative time was (130.3±40.5) min (range, 85-250 min), and the blood loss was (106.2±82.9) ml (range, 20-400 ml). The derivative value of the fitting function y was calculateed y′=2.4×10-6x3+0.0006x2-00768x+1.4742. The kvalue of each operation corresponded to the derivative value of the fitting function. The kvalue of CUSUM learning curve after 25 operations was negative. ConclusionThe learning curve of TULESS of total hysterectomy shows that after 25 cases of operation，the surgeon with experience of more than 30 cases of multitrocar laparoscopic total hysterectomy can perform quickly and safely.

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备注/Memo

备注/Memo:
基金项目：重庆市卫生适宜技术推广项目（2021jstg010）；重庆市人民医院医学科技创新基金项目（Y2020MSXM12）**通讯作者，Email:chencheng961@126.com ①(陆军军医大学第一附属医院西南医院妇产科，重庆400038)
更新日期/Last Update: 2023-02-23