外科理论与实践

外科理论与实践 ›› 2019, Vol. 24 ›› Issue (04): 320-324.doi: 10.16139/j.1007-9610.2019.04.010

• 论著 • 上一篇    下一篇

机器人甲状腺切除手术学习曲线：单个术者的研究

孙寒星, 高浩基, 应夏洋, 黄海燕, 吕恬, 陈曦, 李勤裕, 邱伟华, 严佶祺   

  1. 上海交通大学医学院附属瑞金医院外科,上海 200025
  • 收稿日期:2019-01-10 出版日期:2019-07-25 发布日期:2019-08-25
  • 通讯作者: 严佶祺,E-mail:yanjiqi@aliyun.com

Learning curve for robotic thyroidectomy: a single surgeon experience

SUN Hanxing, GAO Haoji, YING Xiayang, HUANG Haiyan, LÜ Tian, CHEN Xi, LI Qinyu, QIU Weihua, YAN Jiqi   

  1. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2019-01-10 Online:2019-07-25 Published:2019-08-25

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摘要： 目的： 总结机器人甲状腺手术开展经验,探讨手术学习曲线。方法： 回顾分析2015年5月至2017年8月间我院开展的最初200例机器人甲状腺手术。手术入路为双侧腋下-乳晕入路（bilateral axillo-breast approach, BABA）。评估临床病理资料、手术时间等。结果： 在手术量积累到35例后,首次出现手术时间缩短并平稳。在80例后,手术时间再次缩短并稳定。据此,将病例分为A（前35例）、B（第36~80例）、C（第81~200例）三组,并比较临床资料。三组间在性别、年龄、肿瘤最大径上差异无统计学意义（P>0.05）。三组手术时间依次减少,分别为（145.6±42.6） min、（116.2±29.2） min、（88.2±26.1） min。组间差异显著（P=0.001）。三组间术后住院时间减少（P=0.031）、术中出血量减少（P=0.001）和淋巴结清扫数增加（P=0.001）,差异显著。结论： BABA机器人甲状腺切除手术学习曲线为35例左右。累积手术量80例时,达到相对稳定高效。

关键词: 机器人, 甲状腺切除, 淋巴结清扫, 学习曲线

Abstract: Objective To summarize the experience of robotic thyroidectomy in our hospital and the learning curve of robotic thyroidectomy. Methods The first 200 cases with robotic thyroidectomy using bilateral axillo-breast approach (BABA) in our hospital from May 2015 to August 2017 were retrospectively studied. Clinical data including operation time and pathological data were analyzed. Results The operative time decreased significantly and reached the plateau after first 35 cases. Eighty cases later, further decrease in operative time and second plateau were found. The patients then were divided into three groups including group A (first 35 cases), group B (36 th to 80 th cases) and group C (81 st to 200 th cases). There was no significant difference in gender, age and maximum tumor size among three groups (P>0.05). Operative time reduced sequentially from groups A (145.6±42.6 min) to group B (116.2±29.2 min) to group C (88.2±26.1 min) (P=0.001). The decrease in both hospital stays (P=0.031) and intraoperative blood loss (P=0.001) and the increase in number of lymph node dissected (P=0.001) were present among three groups. Conclusions The learning curve of robotic thyroidectomy with BABA was about 35 cases. When the cases reached to 80 cases, the procedure would be safe and effective.

Key words: Robot, Thyroidectomy, Lymph node dissection, Learning curve

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