【摘要】 目的探讨经脐单孔腹腔镜胆囊切除术的学习曲线,以指导人才培养及提高手术安全性。方法回顾性分析2010年3月~2014年8月同一术者94例经脐单孔腹腔镜胆囊切除术的病例资料,男29例,女65例。胆囊结石61例,均有慢性胆囊炎病史;胆囊息肉样病变33例。年龄(41±12)岁(21~77岁)。BMI(24±4)(15~34)。通过累积求和分析法(cumulative summation,CUSUM),得出单孔腹腔镜胆囊切除术的学习曲线。结果手术时间(78.1±24.2)min(45~167min),出血量(8.5±3.6)ml(2~20 ml)。术中胆囊破损9例(9.6%),胆囊床出血或胆囊动脉损伤出血3例(3.2%),手术中转5例(5.3%)。35例手术后,CUSUM学习曲线k值为负。结论通过累积求和分析法得出单孔腹腔镜胆囊切除术的学习曲线特征,并且在35例以后可以跨越学习曲线。更多还原

【Abstract】 Objective To investigate the learning curve of transumbilical single-incision laparoscopic cholecystectomy( SILC) in one laparoscopic center for personnel training and surgical safety improvement. Methods Clinical data of 94 patients who received transumbilica SILC from March 2010 to August 2014 were analyzed retrospectively. The patients included 29 males and 65 females. There were 61 cases of chronic calculus cholecystitis and 33 cases of polypoid lesions of the gallbladder. The average age was41 ± 12 years old( range,21- 77 years old). The mean BMI was 24 ± 4( range,15- 34). The learning curve of SILC was drawn by using cumulative summation( CUSUM). Results The operative time was 78. 1 ± 24. 2 min( range,45- 167 min) and the average blood loss was 8. 5 ± 3. 6 ml( range,2- 20 ml). Rupture of the gallbladder occurred in 9 cases( 9. 6%) during the operation.Hemorrhage caused by gallbladder bed or cystic artery injury occurred in 3 cases( 3. 2%). Additional ports were required in 5 cases( 5. 3%) during the operation. After 35 operations,the k value was negative in cumulative sum control chart. Conclusions The features of learning curve for SILC can be drawn by using the CUSUM analysis. After 35 cases of operation of SILC,the surgeon will operate quickly and safely.更多还原