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低流量胰腺中心腹腔镜胰十二指肠切除术安全性及学习曲线初探

A preliminary exploration on safety and learning curve of laparoscopic pancreatoduodenectomy in low-flow pancreatic center

    摘要
  • 摘要:
    目的 比较腹腔镜胰十二指肠切除术(LPD)与开腹胰十二指肠切除术(OPD)的安全性，并分析LPD的学习曲线及不同阶段的安全性。
    方法 回顾性分析2020年1月—2024年6月南京医科大学附属苏州医院肝胆胰外科50例LPD和54例OPD患者的临床资料，比较术中和术后情况。采用累积求和分析法(CUSUM)分析LPD学习曲线的技术节点。
    结果 LPD组与OPD组手术时间、术中出血量差异无统计学意义(P>0.05)。LPD组与OPD组胰瘘(B、C级)、胃排空延迟、术后出血、胆瘘、腹腔感染发生率比较，差异无统计学意义(P>0.05)。根据患者手术时间和手术序数绘制手术时间序列图，得出拟合曲线。曲线分析显示，本中心实施17例和24例手术时即完成初始阶段和平稳阶段。LPD学习曲线可分为3个阶段: 阶段Ⅰ为初始阶段(第1~17例)，阶段Ⅱ为平稳阶段(第18~24例)，阶段Ⅲ为熟练阶段(第25~50例)。阶段Ⅱ及阶段Ⅲ手术时间短于阶段Ⅰ, 阶段Ⅰ术中失血量多于阶段Ⅲ, 差异均有统计学意义(P < 0.05)。3个阶段并发症发生率差异无统计学意义(P>0.05)。
    结论 LPD和OPD在适应证和安全性方面无明显差异。LPD学习曲线可分为3个阶段。随着手术完成例数的增加，医师手术完成时间逐步缩短，患者并发症发生率逐步降低。

     

    Abstract:
    Objective To compare the safety of laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) and analyze the learning curve and safety at different stages of LPD.
    Methods A retrospective analysis was conducted on the clinical data of 50 LPD patients and 54 OPD patients in the Department of Hepatopancreatobiliary Surgery of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2024, and intraoperative and postoperative conditions were compared. The Cumulative Sum (CUSUM) analysis method was used to analyze the technical nodes of the LPD learning curve.
    Results There were no significant differences in operation time and intraoperative blood loss between the LPD group and the OPD group (P>0.05). There was also no significant difference in the incidence rates of pancreatic fistula (grade B and C), delayed gastric emptying, postoperative bleeding, biliary fistula and intra-abdominal infection between the LPD group and the OPD group (P>0.05). A time series plot of operation time was drawn based on the patient's operation time and surgical sequence, yielding a fitted curve. Curve analysis showed initial stage and stable stage were finished at the 17th and 24th cases. The LPD learning curve could be divided into three stages: stage Ⅰ characterized as the initial stage (cases 1 to 17), stage Ⅱ characterized as the stable stage (cases 18 to 24), and stage Ⅲ characterized as the proficient stage (cases 25 to 50). The operation time in stages Ⅱ and Ⅲ was significantly shorter than that in stage Ⅰ, and the intraoperative blood loss in stage Ⅰ was significantly higher than that in stage Ⅲ (P < 0.05). There was no significant difference in the incidence of complications among the three stages (P>0.05).
    Conclusion LPD and OPD show no significant differences in indications and safety. The LPD learning curve can be divided into three stages. As the number of surgeries completed increases, the operation time of physicians gradually shortens, and the incidence of complications of patients gradually decreases.

     

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