论文部分内容阅读
目的探讨外科医师如何尽快掌握腹腔镜结直肠癌根治术。方法分析2000年9月至2003年5月由同一组医师完成的50例腹腔镜结直肠癌根治术,按手术先后次序分5组,每组10例,比较各组手术时间、术中出血量、术后肛门排气时间、术后住院天数和各组病灶的位置和术后并发症发生率、腹腔镜手术占同期同类手术比例和3站淋巴结清扫数目及其总数的差异。结果A组手术时间由(314.5±34.4)min至E组降为(186.0±27.6)min(P=0.000),术中出血量由(94.0±25.5)ml降至(15.5±18.3)ml(P=0.000)。肛门排气时间、住院天数、病灶的位置、术后并发症发生率、3站淋巴结清扫数及总数各组比较,差异均无显著性意义(P>0.05)。但E组无术中并发症及中转开腹。腹腔镜手术占同期同类手术总数由A组的15.2%(10/66)至E组上升为47.6%(10/21)(P=0.004);全组吻合口瘘发生率为2.0%(1/50),局部复发率为4.0%(2/50)。结论腹腔镜结直肠癌根治术学习曲线大约为40例,即可达到较熟练程度。
Objective To investigate how surgeons to master laparoscopic radical mastectomy as soon as possible. Methods From September 2000 to May 2003, 50 cases of laparoscopic colorectal cancer radical resection performed by the same group of physicians were divided into 5 groups according to the order of operation, 10 cases in each group. The operation time, blood loss , Postoperative anal exhaust time, postoperative hospital stay and the location of each group of lesions and the incidence of postoperative complications, laparoscopic surgery accounted for the same period the proportion of similar surgical procedures and three stations of lymph node dissection number and the total number of differences. Results The operative time in group A decreased from (314.5 ± 34.4) min to (186.0 ± 27.6) min in group E (P = 0.000), and the bleeding volume decreased from (94.0 ± 25.5) ml to (15.5 ± 18.3) ml = 0.000). There was no significant difference in anal exhaust time, days of hospitalization, location of lesions, incidence of postoperative complications, number of lymph node dissection at 3 stations and total number of each group (P> 0.05). However, there was no intraoperative complications in group E and laparotomy. Laparoscopic surgery accounted for 47.6% (10/21) of the total surgeries in the same period from 15.2% (10/66) in Group A to E (P = 0.004); the incidence of anastomotic fistula was 2.0% (1 / 50). The local recurrence rate was 4.0% (2/50). Conclusions The learning curve of laparoscopic radical resection of colorectal cancer is about 40, which can reach a more proficient level.