摘要
目的:探讨单孔胸腔镜(uniportal video-assisted thoracoscopic surgery, UVATS)肺段与肺亚段切除术的学习曲线与近期疗效。方法:回顾性分析2019年12月至2022年9月徐州市中心医院同一术者连续开展的UVATS肺段与肺亚段切除术的病例资料，以手术时间为评价指标，应用累积和分析法(cumulative sum analysis, CUSUM)评估其学习曲线。结果:全组患者平均手术时间118 min。CUSUM学习曲线最佳拟合方程为y＝0.0003x3－0.2498x2+56.813x－615.63(x为手术例数)，拟合系数R2为0.9175。依据CUSUM拟合方程斜率变化，将学习曲线大致分为三个阶段(提升组100例、平台组100例、熟练组223例)。熟练组与提升组、平台组比较，手术时间短[(102.2±51.6)min vs. (143.6±63.3)min vs.(128.3±55.3)min, P<0.05]，术中出血量少[(71.6±41.9)ml vs.(97.5±97.3)ml vs.(81.6±54.7)ml, P<0.05]，胸管总引流量少[(465.2±392.4)ml vs.(705.3±628.6)ml vs.(612.1±500.9)ml, P<0.05]。各组患者切除淋巴结枚数差异无统计学意义(P>0.05)。全组患者术后3个月无非计划二次住院。结论:UVATS肺段与肺亚段切除术是安全、可行的，近期疗效满意。在近3年的时间跨度内，熟练掌握UVATS肺段与肺亚段切除术的学习曲线约200例。
Abstract
Objective:To explore the learning curve and short-term efficacy of uniportal video-assisted thoracoscopic surgery (UVATS) pulmonary segmentectomy and subsegmentectomy.Methods:The clinical data of UVATS pulmonary segmentectomy and subsegmentectomy performed consecutively by the same surgeon in Xuzhou Central Hospital from December 2019 to September 2022 were retrospectively reviewed. Cumulative sum analysis (CUSUM) based on the operation time was used to evaluate the learning curve of this procedure.Results:The average operation time was 118 minutes. The best fitting equation of the CUSUM learning curve was y=0.0003x3 - 0.2498x2+ 56.813x - 615.63 (x stands for the number of surgical cases), and the fitting coefficient R2 was 0.9175. The learning curve was divided into three stages roughly (the promotion group with 100 cases, the platform group with 100 cases, and the proficiency group with 223 cases) according to the change of the fitting equation′s slope. Compared with the promotion and platform groups, the patients in the proficiency group reported shorter operation time [(102.2 ± 51.6) min vs. (143.6 ± 63.3) min vs. (128.3 ± 55.3) min, P<0.05], less intraoperative blood loss [(71.6 ± 41.9) ml vs. (97.5 ± 97.3) ml vs. (81.6 ± 54.7) ml, P<0.05], and less chest drainage volume [(465.2 ± 392.4) ml vs. (705.3 ± 628.6) ml vs. (612.1 ± 500.9) ml, P<0.05]. There was no significant difference in terms of the number of the harvested lymph nodes among these groups (P>0.05). Unplanned readmission or death within 3 months after the operation was not recorded in this cohort.Conclusions:UVATS pulmonary segmentectomy and subsegmentectomy is technically safe and feasible, followed by satisfactory short-term efficacy. In a nearly 3-year interval, the learning curve of UVATS pulmonary segmentectomy and subsegmentectomy is about 200 cases before the surgeon could proficiently master this procedure.
万方数据