目的 分析达芬奇机器人肺段切除术的学习曲线.方法 采用累积和分析法(cumulative sum analysis,CUSUM)分析中国人民解放军北部战区总医院2018年2月-2020年12月完成的达芬奇机器人肺段切除术的学习曲线.通过手术时间拟合得到学习曲线,以R2判断拟合优度.对不同阶段学习曲线的临床资料进行对比分析.结果 纳入第1～50例达芬奇机器人肺段切除术患者,其中男24例、女26例,平均年龄(61.9± 10.6)岁.手术时间随手术例数的累积呈逐渐缩短趋势,拟合优度系数在R2=0.907时达到最大值(P＜0.001),最佳拟合方程为CUSUM(n)=0.009×n3-0.953×n2+24.968×n-7.033(n为手术例数),拟合曲线在手术例数到第17例(n=17)时,实现顶点跨越,以17例为分界将50例手术患者分为两个阶段,即初期学习阶段和熟练掌握阶段.两个阶段的手术时间、术中出血量、术后引流量、淋巴结清扫数目、术后置管时间、术后住院时间、术后并发症差异均有统计学意义(P＜0.05).结论 通过CUSUM法绘制达芬奇机器人肺段切除的学习曲线,当手术例数累计达到17例时,手术可取得满意效果.
Study on learning curve of Da Vinci robotic segmentectomy
Objective To analyze the learning curve of Da Vinci robotic segmentectomy.Methods Cumulative sum analysis(CUSUM)was used to analyze the learning curve of Da Vinci robotic segmentectomy performed by the General Hospital of Northern Theater Command from February 2018 to December 2020.The learning curve was obtained by fitting,and R2 was used to judge the goodness of fitting.The clinical data of patients in different stages of learning curve were compared and analyzed.Results The first 50 patients who received Da Vinci robotic segmentectomy were included,including 24 males and 26 females,with an average age of 61.9±10.6 years.The operation time decreased gradually with the accumulation of operation patients.The goodness of fitting coefficient reached the maximum value when R2=0.907(P＜0.001),CUSUM(n)=0.009×n3-0.953×n2+24.968×n-7.033(n was the number of patients).The fitting curve achieved vertex crossing when the number of patients reached 17.Based on this,50 patients were divided into two stages:a learning and improving stage and a mastering stage.There were statistical differences in the operation time,intraoperative blood loss,postoperative drainage volume,number of lymph node dissection,postoperative catheter time,postoperative hospital stay,and postoperative complications between the two stages(P＜0.05).Conclusion It shows that the technical competency for assuring feasible perioperative outcomes can be achieved when the cumulative number of surgical patients reaches 17.
Da Vinci robotsegmentectomycumulative sum analysislearning curve
万方数据
维普
