摘要
目的:比较机器人与胸腔镜胸腺切除术学习曲线。方法:回顾性收集徐州医科大学附属医院一名胸外科医生在初始学习阶段的60例数据，包括2018年2月至2020年2月进行的30例胸腔镜胸腺切除术及2020年3月至2022年5月进行的30例机器人胸腺切除术的围手术期数据。采用累积和（CUSUM）的方法分别拟出胸腔镜和机器人胸腺切除术的学习曲线，并比较两者的围手术期结局。结果:电视胸腔镜手术（VATS）组在第15例手术跨越了学习曲线拐点，相应划分为学习期和掌握期。机器人辅助胸腔镜手术（RATS）组学习曲线拐点出现稍晚，将其划分成前16例的学习期以及17例之后的掌握期。与VATS组比较，RATS组围手术期胸腔引流时间和术后住院时间明显缩短。两组手术时间差异无统计学意义（P＝0.127），但RATS组的中位手术时间要长于VATS组。两组胸腔引流量差异无统计学意义（P>0.05）。结论:对于机器人胸腺切除术，即使具有胸腔镜手术经验，仍需要相似的学习过程。
Abstract
Objective:To compare the learning curve of robot-assisted thymectomy with that of video-assisted thymectomy.Methods:Data from 60 thoracic surgeries performed by a thoracic surgeon in the training stage were retrospectively collected in the Affiliated Hospital of Xuzhou Medical University, including 30 cases of thoracoscopic thymectomy from February 2018 to February 2020 and 30 cases of robotic thymectomy from March 2020 to May 2022. The learning curves of video-assisted thymectomy and robot-assisted thymectomy were drawn by cumulative sum method, and the perioperative outcomes of the two approaches were compared.Results:In the video-assisted thoracoscopic surgery (VATS) group, the inflection point of the learning curve was crossed in the 15th procedure, which was divided into the learning phase and the mastery phase. In the robot-assisted thoracoscopic surgery (RATS) group, the inflection point of the learning curve occurred later, including the learning period of the first 16 cases and the mastery period after the 17th. In the comparison of perioperative data, the thoracic drainage time and postoperative length of stay in the RATS group were significantly shorter than those in the VATS group. Although there was no significant difference in operation time between the two groups (P=0.127) , the median operation time in the RATS group was longer than that in the VATS group. There was no significant difference in thoracic drainage between the two groups.Conclusions:For robot-assisted thymectomy, a similar learning process is required, even with thoracoscopic surgery experience.
基金项目
徐州市重点研发计划(社会发展)项目(KC22097)
万方数据