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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 560 -565. doi: 10.3877/cma.j.issn.1674-3253.2024.06.005

临床研究

基层医院单一术者改良单通道腹腔镜下鞘状突环扎术学习曲线及体会
江东根1,2, 依力夏提·艾力2, 依布拉音江·阿布力克木2, 依力盼·依拉木2, 冯瑶2, 艾尼玩·木拉克2, 艾克拜尔江·阿里木2,()   
  1. 1.518107 深圳,中山大学附属第七医院泌尿外科
    2.844099 新疆维吾尔自治区,喀什市人民医院泌尿外科
  • 收稿日期:2024-04-22 出版日期:2024-12-01
  • 通信作者: 艾克拜尔江·阿里木
  • 基金资助:
    广东省卫生健康适宜技术推广项目(202405201959564634)深圳市科创委面上项目(JCYJ20210324 123006018)

The learning curve and experiences of modified single-port laparoscopic ligation of patent processus vaginalis by single surgeon in primary hospital

Donggen Jiang1,2, Yao Feng2   

  1. 1.Department of Urology,Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518107,China
    2.Department of Urology,Kashgar People's Hospital,Xinjiang Uygur Autonomous Region 844099,China
  • Received:2024-04-22 Published:2024-12-01
引用本文:

江东根, 依力夏提·艾力, 依布拉音江·阿布力克木, 依力盼·依拉木, 冯瑶, 艾尼玩·木拉克, 艾克拜尔江·阿里木. 基层医院单一术者改良单通道腹腔镜下鞘状突环扎术学习曲线及体会[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 560-565.

Donggen Jiang, Yao Feng. The learning curve and experiences of modified single-port laparoscopic ligation of patent processus vaginalis by single surgeon in primary hospital[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 560-565.

目的

探讨基层医院单一术者开展改良经脐单通道腹腔镜下鞘状突环扎术的学习曲线并分享手术体会。

方法

回顾性分析2023年7月至2024年1月喀什市人民医院泌尿外科同一医师主刀的25例改良经脐单通道腹腔镜下鞘状突环扎术患儿临床资料。采用累积和分析法(CUSUM)根据单侧修复时间及手术例数绘制学习曲线并进行拟合,确定进入学成期的病例数,并对比分析学成前后差异。

结果

纳入研究的患儿男性18例,女性7例,单侧21例,双侧4例。所有手术均顺利完成,无增加操作通道或中转开放。5例术前诊断为单侧病变,但术中发现对侧同时存在鞘状突未闭患儿均予以同期结扎。CUSUM学习曲线最佳拟合模型为y=0.02x3-1.079x2+14.732x+0.529(x表示手术例数),拟合优度R2=0.938。曲线在累积至第9例经验时跨越顶点,进而以此为界分为学习期与学成期。两组在术中出血量、术后疼痛评分、外观评分、术后住院时间方面差异均无统计学意义,学成期单侧修复时间明显短于学习期[(16±5)min vs (28±5)min,P<0.001]。术后随访1个月两组均未出现明显并发症。

结论

改良经脐单通道腹腔镜下鞘状突环扎术安全、有效,累积9例手术经验后可熟练掌握该技术,适合在基层医院应用推广。

Objective

To explore the learning curve and share surgical experiences of modified trans-umbilical single-port laparoscopic ligation of patent processus vaginalis by single surgeon in a primary hospital.

Methods

A retrospective analysis was conducted on the clinical data of 25 children,who underwent modified trans-umbilical single-port laparoscopic ligation of patent processus vaginalis by single surgeon in the Urology department of Kashgar People's Hospital,from July 2023 to January 2024.The learning curve was generated using cumulative sum analysis (CUSUM) method based on cumulative number of surgical cases and the unilateral repair time. After the number of surgical cases required to enter the vertex of the learning curve was determined,the differences between the learning and completion stage were compared.

Results

18 male and 7 female pediatric patients were included in the study,with 21 unilateral and 4 bilateral deficiencies. All surgeries were successfully completed without any additional operating channels or conversion to open surgery. Five cases preoperatively diagnosed as unilateral lesion were identified to have a contralateral patent processus vaginalis intraoperatively and received simultaneous repair surgery. The best fitting model for the CUSUM learning curve was a cubic curve with the equation:y= 0.02x3-1.079x2+14.732x+0.529 (x is the number of surgical cases),which had a high fitting coefficient R2=0.938. The fitting curve crossed the vertex when accumulating to the 9th case,which was recognized as the cut point for dividing the curve into learning stage and the completion stage. No significant difference was found between the two groups in terms of intraoperative blood loss,postoperative pain score,appearance score,and postoperative hospital stay,while the unilateral repair time in the completion stage was significantly shorter than that in the learning stage [(16±5) min vs (28±5) min,P<0.001]. There were no significant complications in both groups after 1 month of follow-up.

Conclusions

The modified transumbilical single-port laparoscopic ligation of patent processus vaginalis is safe and effective. The technique can be proficiently mastered after accumulating 9 surgical experiences,which is suitable for application and promotion in grassroots hospitals.

图1 单一术者改良单通道腹腔镜下鞘状突环扎术CUSUM学习曲线图
图2 鞘状突环扎术手术例数与手术时间散点图
表1 单一术者行25例改良单通道腹腔镜下鞘状突环扎术学习期与学成期临床资料比较
视频1 经脐单通道腹腔镜下鞘状突环扎术
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