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目的:探讨机器人辅助腹腔镜肾部分切除术(RAPN)治疗肾肿瘤的学习曲线。方法:回顾性分析2012年5月~2013年8月由单一术者连续完成的40例RAPN患者的临床资料,按手术先后分为4组:第1组(1~10例)、第2组(11~20例)、第3组(21~30例)、第4组(31~40例)。分析对比4组手术时间、热缺血时间、并发症、肾功能等指标。结果:4组患者年龄、肿瘤最大径、R.E.N.A.L.评分等基线数据差异无统计学意义,而手术总时间[(202.20±18.06)min、(194.70±11.68)min、(160.30±14.28)min、(155.20±22.29)min,P<0.01]、热缺血时间[(31.80±10.73)min、(27.10±4.56)min、(16.85±7.01)min、(15.00±6.32)min,P<0.01]的差异有统计学意义,且随着例数增多,呈现逐渐下降的趋势。术中出血量虽呈现下降趋势,但各组之间差异并无统计学意义[(145.00±59.86)ml、(140.00±65.83)ml、(115.00±47.43)ml、(110.00±31.62)ml,P=0.360]。两两对比发现第1组和第2组、第3组和第4组在手术时间和热缺血时间上差异并无统计学意义(P>0.05),而第2组和第3组之间差异有统计学意义(P<0.01)。结论:对于一位有着丰富腹腔镜手术经验的术者,实现普通腹腔镜到RAPN的过渡是一个顺利、快速的过程,学习曲线为15~20例。学习曲线存在个体差异性,术者应根据自身经验选择合适患者,实现手术效果的最优化。
Objective: To investigate the learning curve of robot assisted laparoscopic partial nephrectomy (RAPN) in the treatment of renal tumors. Methods: The clinical data of 40 RAPN patients consecutively performed by a single operation from May 2012 to August 2013 were retrospectively analyzed. The patients were divided into 4 groups according to the operation: group 1 (1-10 cases), group 2 (11 to 20 cases), group 3 (21 to 30 cases) and group 4 (31 to 40 cases). Analysis and comparison of 4 groups of operation time, warm ischemia time, complications, renal function and other indicators. Results: There was no significant difference in the baseline data of age, tumor diameter and RENAL score between the four groups (P0.05), while the total time of operation was (202.20 ± 18.06) min, (194.70 ± 11.68) min, (160.30 ± 14.28) min, ± 22.29) min, P <0.01]. The difference of warm ischemia time [(31.80 ± 10.73) min, (27.10 ± 4.56) min, (16.85 ± 7.01) min, (15.00 ± 6.32) min, P <0.01] Statistical significance, and as the number of cases increased, showing a gradual downward trend. Although the amount of bleeding during operation showed a downward trend, there was no significant difference between the groups (145.00 ± 59.86 ml, (140.00 ± 65.83) ml, (115.00 ± 47.43) ml, (110.00 ± 31.62) ml, P = 0.360]. There was no significant difference between the first group and the second group, the third group and the fourth group in the operation time and the time of warm ischemia (P> 0.05), while between the second group and the third group The difference was statistically significant (P <0.01). CONCLUSIONS: For a surgeon with extensive experience in laparoscopic surgery, the transition from conventional laparoscopy to RAPN is a smooth and rapid progression with a learning curve of 15-20. There are individual differences in the learning curve, the surgeon should choose the appropriate patient based on their own experience, to achieve the optimal surgical results.