Learning curve of radical hepatectomy in treating hepatic alveolar echinococcosis with vascular infiltration:a cumulative sum analysis
Objectives To evaluate the learning curve of radical hepatectomy combined with vascular and/or bile duct reconstruction(RHVBR)in the treatment of hepatic alveolar echinococcosis(HAE),and to explore the feasibility and safety of RHVBR.Methods The clinical data of 203 patients who received RHVBR treatment for HAE complicated with vascular invasion in West China Hospital from 2010 to 2018 were analyzed retrospectively.Cumulative sum(CUSUM)and risk-adjusted cumulative sum(RA-CUSUM)were used to analyze the learning curve of RHVBR,determine the learning stage,and compare the differences of intraoperative and postoperative outcome indexes in different learning stages.Results The average operative time was(537.9±207.6)minutes,with blood loss amounted to 617.3(138.9,1 094.2)mL.Postoperative complications occurred in 65 cases,and the incidence of complications was 32.0％.Among them,29 cases(14.3％)had serious complications.Three cases(1.5％)died within 90 days after operation.The results of RA-CUSUM analysis showed that 54 cases of surgery were the cut-off point of learning curve for serious postoperative complications.According to the results of CUSUM analysis,the whole queue was divided into the first stage(n=53)and the second stage(n=150)based on the completion of 53 operations.Compared with the first stage,the operative time and total postoperative hospital stay in the second stage was shortened,the incidence of serious complications was reduced,and the number of resected liver segments was increased.The differences were statistically significant(P＜0.05).Conclusion It is feasible and safe to treat HAE with RHVBR,and the incidence of serious complications is obviously reduced after 54 cases of operation.
hepatic alveolar echinococcosisliver resectionvascular reconstructionbile duct reconstructioncumulative sum analysisrisk-adjusted cumulative sum analysis
万方数据
维普
