探讨标准化三步法操作流程在改善经腹入路腹腔镜肾癌根治学习曲线中的应用。

回顾性分析我院自2015年2月至2017年5月间由同一位医师实施的经腹入路腹腔镜肾癌根治术的60例患者病历资料，患者资料入院时间先后顺序整理，分实验组和对照组两组，每组选取患者30例，对照组时间范围为2015年2月至2016年7月，期间主刀医生未按照标准三步法手术流程操作，实验组时间范围为2016年8月至2017年5月，期间主刀医师均按照"标准化三步法"操作流程进行操作。

两组的年龄，体重，肿瘤侧别以及肿瘤大小比较差异无统计学意义（P>0.05）。实验组手术时间为（100±27）min，低于对照组（117±33）min，两者比较差异有统计学意义（t=6.374，P<0.05），实验组手术出血量为（142±50）ml，显著低于对照组（201±75）ml，差异有统计学意义（P<0.01），实验组术后并发症发生率3.33%，对照组术后并发症发生率6.66%，差异有统计学意义（P<0.05），两者住院时间差异无统计学意义（P>0.05）。我们以手术时间为参照，描绘两组的学习曲线，发现实验组约15例达到平台期，对照组25例左右达到平台期，两组比较差异有统计学意义（P<0.05）。

通过标准化三步法操作流程实施经腹腔入路肾癌根治术，能够减少手术时间，减少术中出血量，缩短手术的进程，改善手术的学习曲线。

To explore the application of standardized three-step approach in improving the learning curve of laparoscopic radical nephrectomy via trans-abdominal approach.

Clinical data of 60 patients undergoing laparoscopic radical nephrectomy via trans-abdominal approach performed by the same surgeon in our hospital from February 2015 to May 2017 were retrospectively analyzed. Clinical data were collected according to the date of admission and divided into the experimental (n=30) and control groups (n=30). In the control group, patients enrolled from February 2015 to July 2016 underwent surgery without the standardized three-step approach. In the experimental group, those enrolled from August 2016 to May 2017 received surgery with the standardized three-step approach.

Age, weight, tumor side and size had no difference between two groups (allP>0.05). The operation time in the experimental group was (100±27) min, shorter than that in the control group (117±33) min (t=6.374,P<0.05). In the experimental group, the intraoperative blood loss was less than the control group [(142±50) ml vs (201±75) ml,P<0.01]. The incidence of postoperative complications was different between the experimental and control groups (3.33% vs 6.66%,P<0.05). The length of hospital stay wasn't different between the two groups (P>0.05). The learning curve was delineated by referring to the operation time. In the experimental group, 15 patients reached the plateau phase and 25 cases in the control group (P<0.05).

The radical nephrectomy through the standardized three-step approach can reduce operation time, decrease intraoperative blood loss, shorten surgical process and improve learning curve of the surgery.