经剑突下路径胸腔镜下全胸腺切除术学习曲线分析
|
摘要
目的:探讨经剑突下路径胸腔镜下全胸腺切除术的学习曲线,总结开展该手术的技术要点。方法:回顾性分析我院胸外科于2015年10月至2017年10月最开始行全胸腺切除术的患者临床资料,其中男21例,女16例,采用累积和分析法(cumulative sum analysis,CUSUM)对经剑突下路径胸腔镜下全胸腺切除术的学习曲线进行分析。结果:平均手术时间为123.7 min,最佳拟合曲线为三次方曲线,拟合方程为CUSUN(min)=89.703 7X-4.594 8X2+0.059 9X3(X为手术例数)。学习曲线跨越顶点为13例,以13例为界限,将病例分为A、B 2组。A组和B组在手术时间、术后住院天数、术后胸腔引流管放置时间、术后并发症比较,差异有统计学意义,而术中出血量比较差异无统计学意义。结论:本研究中,13例是跨越经剑突下路径胸腔镜下全胸腺切除术学习曲线所需要累积的最低手术例数。
Objective:To investigate the learning curve of total thymectomy under subxiphoid process thoracoscopy and to summarize the technical points of the operation. Methods:The clinical data of patients undergoing total thymectomy from the beginning of October2015 to October 2017 in our hospital were retrospectively analyzed. There were 21 males and 16 females. The cumulative sum analysis(CUSUM)analyzed the learning curve of total thymectomy under subxiphoid process thoracoscopy. Results:The average operation time was 123.7 min. The best fitting curve was cubic curve. The fitting equation was CUSUN(min)=89.703 7 X-4.594 8 X2 + 0.059 9 X3(X is the number of operation). Learning curve across the apex was observed in 13 cases. Taking 13 cases as the boundary,all cases were divided into A group and B group. There was no significant difference between the two groups in the operation time,but there were statistical differences in postoperative hospital stay,postoperative chest drainage tube placement time,postoperative complications between the two groups. Conclusion:In this study,13 cases are the lowest cumulative number of surgeries needed to span the learning curve of total thymectomy under subxiphoid process thoracoscopy.
Objective:To investigate the learning curve of total thymectomy under subxiphoid process thoracoscopy and to summarize the technical points of the operation. Methods:The clinical data of patients undergoing total thymectomy from the beginning of October2015 to October 2017 in our hospital were retrospectively analyzed. There were 21 males and 16 females. The cumulative sum analysis(CUSUM)analyzed the learning curve of total thymectomy under subxiphoid process thoracoscopy. Results:The average operation time was 123.7 min. The best fitting curve was cubic curve. The fitting equation was CUSUN(min)=89.703 7 X-4.594 8 X2 + 0.059 9 X3(X is the number of operation). Learning curve across the apex was observed in 13 cases. Taking 13 cases as the boundary,all cases were divided into A group and B group. There was no significant difference between the two groups in the operation time,but there were statistical differences in postoperative hospital stay,postoperative chest drainage tube placement time,postoperative complications between the two groups. Conclusion:In this study,13 cases are the lowest cumulative number of surgeries needed to span the learning curve of total thymectomy under subxiphoid process thoracoscopy.
引文
[1]Davenport E,Malthaner RA.The role of surgery in the management of thymoma:a systematic review[J].Ann Thorac Surg,2008,86(2):673-684.
[2]Luo Y,Pan DJ,Chen FF,et al.Effectiveness of thymectomy,in nonthymomatous myasthenia gravis:a systematic review[J].J Huazhong Univ Sci Technolog Med Sci,2014,34(6):942-949.
[3]Li Y,Wang J.Left-sided approach video-assisted thymectomy for the treatment of thymic diseases[J].World J Surg Oncol,2014,12:398.
[4]Yano M,Moriyama S,Haneda H,et al.The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach[J].World J Surg,2017,41(3):763-770.
[5]Rueckert J,Swierzy M,Badakhshi H,et al.Robotic-assisted thymectomy:surgical procedure and results[J].Thorac Cardiovasc Surg,2015,63(3):194-200.
[6]Migliore M,Alongi G,Rampello L,et al.Video assisted trans-cervical thymectomy:a minimally invasive approach to treat non-thymomatous myasthenia gravis[J].Ann Ital Chir,2013,84(6):667-670.
[7]Jurado J,Javidfar J,Newmark A,et al.Minimally invasive thymectomy and open thymectomy:outcome analysis of 263 patients[J].Ann Thorac Surg,2012,94(3):974-981.
[8]Suda T,Hachimaru A,Tochii D,et al.Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy:initial results?[J].Eur J Cardiothorac Surg,2015,49(s1):54-58.
[9]Bolsin S,Colson M.The use of the Cusum Technique in the assessment of trainee competence in new procedures[J].Int J Qual Health Care,2000,12(5):433-438.
[10]Biswas P,Kalbfleisch JD.A risk-adjusted CUSUM in continuous time based on the Cox model[J].Stat Med,2008,27(17):3382-3406.
[11]Steiner SH,Cook RJ,Farewell VT,et al.Monitoring surgical performance using risk-adjusted cumulative sum charts[J].Biostatistics,2000,1(4):441-452.
[12]吴伟彬,黄邵洪,张健,等.胸腔镜下交感神经切除术治疗手汗症的学习曲线[J].新医学,2012,43(7):473-475.
[13]刘博,汪明敏,许世广,等.达芬奇机器人纵隔肿瘤切除术的学习曲线[J].中国胸心血管外科临床杂志,2017,24(2):127-131.
[14]Ninomiya I,Osugi H,Tomizawa N,et al.Learning of thoracoscopic radical esophagectomy:how can the learning curve be made short and flat?[J].Dis Esophagus,2010,23(8):618-626.
[15]Yano M,Moriyama S,Haneda H,et al.Thymectomy using the subxiphoid approach[J].J Thorac Cardiovasc Surg,2016,152(1):278-279.
[2]Luo Y,Pan DJ,Chen FF,et al.Effectiveness of thymectomy,in nonthymomatous myasthenia gravis:a systematic review[J].J Huazhong Univ Sci Technolog Med Sci,2014,34(6):942-949.
[3]Li Y,Wang J.Left-sided approach video-assisted thymectomy for the treatment of thymic diseases[J].World J Surg Oncol,2014,12:398.
[4]Yano M,Moriyama S,Haneda H,et al.The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach[J].World J Surg,2017,41(3):763-770.
[5]Rueckert J,Swierzy M,Badakhshi H,et al.Robotic-assisted thymectomy:surgical procedure and results[J].Thorac Cardiovasc Surg,2015,63(3):194-200.
[6]Migliore M,Alongi G,Rampello L,et al.Video assisted trans-cervical thymectomy:a minimally invasive approach to treat non-thymomatous myasthenia gravis[J].Ann Ital Chir,2013,84(6):667-670.
[7]Jurado J,Javidfar J,Newmark A,et al.Minimally invasive thymectomy and open thymectomy:outcome analysis of 263 patients[J].Ann Thorac Surg,2012,94(3):974-981.
[8]Suda T,Hachimaru A,Tochii D,et al.Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy:initial results?[J].Eur J Cardiothorac Surg,2015,49(s1):54-58.
[9]Bolsin S,Colson M.The use of the Cusum Technique in the assessment of trainee competence in new procedures[J].Int J Qual Health Care,2000,12(5):433-438.
[10]Biswas P,Kalbfleisch JD.A risk-adjusted CUSUM in continuous time based on the Cox model[J].Stat Med,2008,27(17):3382-3406.
[11]Steiner SH,Cook RJ,Farewell VT,et al.Monitoring surgical performance using risk-adjusted cumulative sum charts[J].Biostatistics,2000,1(4):441-452.
[12]吴伟彬,黄邵洪,张健,等.胸腔镜下交感神经切除术治疗手汗症的学习曲线[J].新医学,2012,43(7):473-475.
[13]刘博,汪明敏,许世广,等.达芬奇机器人纵隔肿瘤切除术的学习曲线[J].中国胸心血管外科临床杂志,2017,24(2):127-131.
[14]Ninomiya I,Osugi H,Tomizawa N,et al.Learning of thoracoscopic radical esophagectomy:how can the learning curve be made short and flat?[J].Dis Esophagus,2010,23(8):618-626.
[15]Yano M,Moriyama S,Haneda H,et al.Thymectomy using the subxiphoid approach[J].J Thorac Cardiovasc Surg,2016,152(1):278-279.