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中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 123 -127. doi: 10.3877/cma.j.issn.1674-392X.2021.02.002

所属专题: 文献

临床论著

腹腔镜下胃底折叠术的学习曲线分析
杜军1, 李俊生2, 费伯建1,(), 金留根1, 蒋晖1, 陈柏1, 谢立飞1   
  1. 1. 214122 江苏无锡,江南大学附属医院胃肠外科
    2. 210009 南京,东南大学附属中大医院普外科
  • 收稿日期:2020-12-01 出版日期:2021-04-18
  • 通信作者: 费伯建

Learning curve of laparoscopic Nissen fundoplication for gastro-esophgeal reflux disease

Jun Du1, Junsheng Li2, Bojian Fei1,(), Liugen Jin1, Hui Jiang1, Bai Chen1, Lifei Xie1   

  1. 1. Department of Gastroenterological Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214122, China
    2. Department of General Surgery, ZhongdaHospital, Southeast University, Nanjing 210009, China
  • Received:2020-12-01 Published:2021-04-18
  • Corresponding author: Bojian Fei
引用本文:

杜军, 李俊生, 费伯建, 金留根, 蒋晖, 陈柏, 谢立飞. 腹腔镜下胃底折叠术的学习曲线分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(02): 123-127.

Jun Du, Junsheng Li, Bojian Fei, Liugen Jin, Hui Jiang, Bai Chen, Lifei Xie. Learning curve of laparoscopic Nissen fundoplication for gastro-esophgeal reflux disease[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(02): 123-127.

目的

评价腹腔镜下胃底折叠术的手术效果以及在不同阶段的差异,探讨其学习曲线。

方法

对同一组术者连续开展的36例腹腔镜下胃底折叠术患者进行分析,对于每例患者的手术时间,采用累积和(CUSUM)分析法绘制腹腔镜胃底折叠书的学习曲线,比较学习曲线不同阶段的手术时间、术中出血量、术后胃肠功能恢复时间,反流性疾病问卷(RDQ)评分,消化病生活质量指数(GLQI)评分及不良反应发生率的差异。

结果

CUSUM法得出曲线最大转折点在19例处,以此为分界将学习曲线划分为学习提高、熟练掌握两个阶段,两个阶段患者的一般资料比较,差异无统计学意义(P>0.05);术者熟练掌握阶段患者的手术时间、术中出血量、术后胃肠功能恢复时间、术后6个月RDQ评分和GLQI评分均优于学习提高阶段(P<0.05)。

结论

通过CUSUM分析法对腹腔镜胃底折叠术的学习曲线进行精准剖析,表明术者驾驭该技术须累积的手术例数为19例。

Objective

Explore the learning curve of laparoscopic Nissen fundoplication (LNF) for gastro-esophageal reflux disease, and evaluate the surgical effect of LNF and differences in different stages.

Methods

Patients (n=36) with LNF were recruited in the study. The cumulative sum analysis (CUSUM) was used to determine the learning curve of LNF for gastro-esophageal reflux disease. The learning curve in different stageswere compared by analyzing the operation time, blood loss, the postoperative recovery time, RDQ score, GLQI score and postoperative complication.

Results

The CUSUM method obtained the maximum turning point of the curve at 19 cases, which divided the learning curve into two stages: learning improvement and mastery. However, the general data of the two stages was not statistically significant (P>0.05). The operation time, blood loss, postoperative gastrointestinal function recovery time, RDQ score and GLQI score at postoperative 6-month were superior in mastery stage than those in learning improvement stage.

Conclusion

Accurate analysis of the learning curve of LNF for gastro-esophageal reflux disease by CUSUM showed that the required number of handling surgical procedure was 19.

图1 累积和分析法曲线图
表1 2个阶段患者术中术后情况比较(±s
表2 两阶段患者术前、术后3和6个月的RDQ评分比较(分,±s
表3 两阶段患者术前、术后3和6个月的GLQI评分比较(分,±s
表4 2个阶段患者术不良反应发生情况比较
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