腹腔镜左肝外叶切除术学习曲线的研究

发布时间：2018-03-11 02:02

本文选题：腹腔镜　切入点：左肝外叶切除术　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究探讨本中心腹腔镜左肝外叶切除术的学习曲线。资料和方法:回顾浙江大学医学院附属邵逸夫医院自1999年6月至2016年8月完成的腹腔镜左肝外叶切除手术,收集和分析169例病例资料,全部手术均由同一医生主导的肝胆胰外科团队实施。按照实施手术的时间先后,将169例患者依次排序并分别编号。收集患者的术前基础资料,主要有性别、年龄、既往上腹部手术史、HBV感染病史、肝功能指标、凝血功能、肝硬化病史、Child-Pugh分级、ASA评分等情况。术中资料包括手术时间、术中出血量、有无采取手助式,有无采取手术中转开腹、肝门有无阻断、术中有无输血。收集术后并发症情况、术后住院天数、术后病理良恶性结果等资料。通过计算手术时间和术中出血量的累积和,将原始数据的散点图转换为累积和散点图,并认为累积和的峰值代表数据趋于稳定的起点,以此作为依据将患者分成早期组和后期组。利用软件(SPSS 20.0)进行统计分析,比较早期组和后期组在手术用时、术中出血量、有无采取手助,手术中转开腹比例、有无利用阻断带行肝门阻断、有无术中输血、术后并发症病例和术后住院天数等参数的差异性。P0.05认为有统计学差异。结果:学习曲线显示经过33例的腹腔镜肝左肝外叶切除术训练后,术者完成该术式所需的时间达到稳定期。学习曲线显示手术出血在完成35例腹腔镜肝左叶切除术后达到稳定期。上述两者在早期和后期的手术时间及术中出血均存在显著差异。结论:本中心腹腔镜下左外叶切除术的学习曲线大致为33-35例。鉴于腹腔镜下左外叶切除相对操作方便、容易学习,对于具备腹腔镜基础的微创外科医生而言,腹腔镜下左外侧肝切除术是一种安全可行的手术方法。
[Abstract]:Objective: to study the learning curve of laparoscopic left extrahepatic lobectomy. Materials and methods: the laparoscopic left extrahepatic lobectomy was performed from June 1999 to August 2016 in run run run Shaw Hospital affiliated to Zhejiang University School of Medicine. The data of 169 cases were collected and analyzed, all of them were performed by the same doctor-led hepatobiliary and pancreatic surgery team. According to the time of operation, 169 patients were sequenced and numbered separately. The preoperative basic data of the patients were collected. Gender, age, previous history of upper abdominal surgery, history of HBV infection, liver function, coagulation function, liver cirrhosis history and Child-Pugh grade ASA score, etc. Whether or not the operation was converted to open surgery, whether the hepatic hilum was blocked or not, whether there was blood transfusion during the operation. The data of postoperative complications, postoperative hospital stay, pathological and malignant results were collected. By calculating the time of operation and the accumulative sum of blood loss during operation, The scattered plot of the original data is converted into the cumulative and scattered plot, and the peak value of the cumulative sum represents the starting point of data stabilization, which is used as the basis to divide the patient into early group and late group. The statistical analysis is carried out by using software SPSS 20.0). To compare the amount of blood loss during operation between the early group and the later group, whether the hands were taken, the proportion of the patients converted to laparotomy, whether to use the blocking band to block the hepatic hilus, and whether there was blood transfusion during the operation. Results: the learning curve showed that there were 33 cases of laparoscopic left lateral hepatic lobectomy after training. The learning curve showed that the operative bleeding was stable after laparoscopic hepatectomy in 35 cases. The operative time and intraoperative bleeding were both in the early and late stages. Conclusion: the learning curve of left lateral lobectomy under laparoscopy is approximately 33-35 cases. In view of the convenience of laparoscopic left lateral lobectomy, Easy to learn, laparoscopic left lateral hepatectomy is a safe and feasible procedure for minimally invasive surgeons with laparoscopic basis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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