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目的:探讨后腹腔镜肾部分切除术治疗局限性肾癌的学习曲线。方法:回顾性分析我院同一组医师连续开展的40例后腹腔镜肾部分切除术患者的临床资料:按手术先后将40例患者依次分为A组(1~10例)、B组(11~20例)、C组(21~30例)和D组(31~40例),比较各组术中出血量、肾热缺血时间、手术时间、胃肠道功能恢复时间、并发症、术后住院时间等指标。结果:四组患者术中出血量、肾热缺血时间和手术时间差异有统计学意义(P<0.05);进一步两两比较发现A组的出血量、肾热缺血时间和手术时间与B组、C组和D组比较,差异有统计学意义(P<0.05),B组的出血量、肾热缺血时间和手术时间与C组和D组比较,差异有统计学意义(P<0.05),而C组的出血量、肾热缺血时间和手术时间与D组比较,差异无统计学意义(P>0.05)。各组患者术后胃肠道功能恢复时间、并发症发生率、术后住院时间比较,差异无统计学意义(P>0.05)。结论:后腹腔镜肾部分切除术的学习曲线大约为20例,即能达到比较熟练的水平和稳定的程度。
Objective: To investigate the learning curve of retroperitoneoscopic partial nephrectomy in the treatment of localized renal cell carcinoma. Methods: The clinical data of 40 patients undergoing retroperitoneal laparoscopic partial nephrectomy were retrospectively analyzed. Forty patients were divided into group A (1-10 cases), group B (11 cases) ~ 20 cases), C group (21 ~ 30 cases) and D group (31 ~ 40 cases). The blood loss, renal ischemia time, operation time, gastrointestinal function recovery time, complications, Postoperative hospital stay and other indicators. Results: There was significant difference between the four groups in the amount of blood loss, the duration of renal ischemia and the operation time (P <0.05); further comparison between two groups showed that the amount of bleeding, the duration of renal ischemia and the time of operation were similar to those of B (P <0.05). The amount of bleeding, renal ischemia time and operation time in group B were significantly different from those in group C and group D (P < 0.05). There was no significant difference in bleeding volume, renal ischemia time and operation time between group C and group D (P> 0.05). The postoperative gastrointestinal function recovery time, complication rate and postoperative hospital stay in each group of patients showed no significant difference (P> 0.05). Conclusion: The laparoscopic partial nephrectomy learning curve is about 20 cases, which can reach a more proficient level and the degree of stability.