腹腔镜肝切除术学习曲线的研究

发布时间：2018-06-07 06:15

本文选题：腹腔镜 + 肝切除　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的：1.探讨适用于临床手术技能学习曲线的计算方法;2.研究探讨腹腔镜下肝左外叶切除及不规则肝切除的学习曲线。方法：回顾性收集、分析解放军总医院行腹腔镜肝左外叶切除术和腹腔镜下不规则肝切除术的患者资料,全部由同一术者领导的手术团队完成。排除临床数据不完整的患者资料。将各部分研究入选的患者按照手术的先后顺序排序、编号。收集患者的性别、年龄、Child-Pugh评分情况、手术时间、术中出血量、手术中转情况、术后住院时间、术后并发症发生情况等指标。将收集的数据的统计学处理分两步进行。①绘制手术时间标准差散点图,并结合术中出血量和术后住院时间标准差散点图确定组距并分组：②采用统计学软件SPSS 20.0进行统计。不同组别患者之间等级数据之间的差异(性别、Child-Pugh评分等级、手术中转情况、术后并发症发生情况)采用Pearsonχ2检验进行比较；不同组别之间定量数据的差异(年龄、手术时间、术中出血量、输血量、术后住院时间)采用方差分析进行比较,并利用LSD法进行不同组别之间定量数据两两分析的比较,P0.05为差异有统计学意义。结果：腹腔镜肝左外叶切除术的手术时间和术中出血量可在完成11例手术后趋于稳定,术后住院时间可在完成21例后趋于稳定；腹腔镜下不规则肝切除的手术时间和术后住院时间可在完成30例手术实践后达到趋于稳定,术中出血量可在完成23例手术后趋于稳定。结论：通过计算标准差峰值确定组距、分组的方法计算学习曲线可用于临床实际情况。
[Abstract]:Purpose 1. To discuss the method of calculating the learning curve of clinical surgical skill. To study the learning curve of laparoscopic left lateral lobectomy and irregular hepatectomy. Methods: the data of patients undergoing laparoscopic left lateral lobectomy and laparoscopic irregular hepatectomy in PLA General Hospital were analyzed retrospectively. Exclude patients with incomplete clinical data. The patients who were selected in each study were ranked and numbered according to the order of operation. The patients' gender, age and Child-Pugh score, operative time, intraoperative blood loss, operation transfer, postoperative hospitalization time, postoperative complications and so on were collected. The statistical processing of the collected data was divided into two steps to draw the standard deviation scatter plot of operation time, and combined with the standard deviation scatter plot of intraoperative bleeding and postoperative hospitalization time, the group distance was determined and divided into two groups. The statistical software SPSS 20.0 was used to make the statistics. Pearson 蠂 2 test was used to compare the difference of grade data between different groups (gender Child-Pugh score, surgical transition, postoperative complications), and the difference of quantitative data (age, operation time, operation time) between different groups. Analysis of variance was used to compare the volume of blood loss, blood transfusion and hospital stay after operation, and the comparison of quantitative data between different groups by LSD method was statistically significant (P0.05). Results: the operative time and intraoperative bleeding volume of laparoscopic left lateral hepatic lobectomy were stable in 11 cases and hospital stay in 21 cases. The operative time and hospitalization time of laparoscopic irregular hepatectomy could be stable after 30 cases of operation practice, and the amount of intraoperative bleeding could be stable after 23 cases of operation. Conclusion: the group distance is determined by calculating the peak value of standard deviation, and the learning curve can be used in clinical practice.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

【共引文献】