作者：孙姚承1,2，汤建军1,2，何俊波3，刘传磊1,2

单位：1.江苏大学附属武进医院 普通外科，江苏 常州 213002；2.徐州医科大学武进临床学院 普通外科，江苏 常州 213002；3.常州市第一人民医院 全科医学科，江苏 常州 213002

Authors: Sun Yaocheng1,2, Tang Jianjun1,2, He Junbo3, Liu Chuanlei1,2

Unit:  1.Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou 213002, Jiangsu, China；2.Department of General Surgery, the Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, Jiangsu, China；3.Department of General Medicine, Changzhou First People's Hospital, Changzhou 213002, Jiangsu, China

摘要：

目的 探讨以肠系膜上动脉为导向的腹腔镜下右半结肠切除术学习曲线，分析不同学习阶段中患者的临床资料和病理资料，为该术式的推广提供参考。方法 回顾性分析江苏大学附属武进医院普通外科同一手术团队在2017年2月至2018年12月实施的54例以肠系膜上动脉为导向的腹腔镜下右半结肠切除术的病例资料，采用累积和(cumulative sum, CUSUM)法拟合学习曲线，根据学习曲线的顶点将患者分为学习提高阶段组（前21例）和熟练掌握阶段组（后33例），并分析不同阶段对于患者临床疗效的影响。结果 学习曲线的最佳拟合方程为院Y=0.008101X³-1.496X²+56.26X+38.33，21例为跨越学习曲线所需要累积的最少手术例数，学习提高阶段组和熟练掌握阶段组患者的一般资料如性别、年龄、体重指数等的差异无统计学意义，术中出血量和手术时间的差异有统计学意义（P＜0.05），并且术后并发症中乳糜漏的发生率差异也有统计学意义（P＜0.05），术后病理学差异无统计学意义。结论 拥有腹腔镜结直肠癌根治术丰富经验的外科医生掌握以肠系膜上动脉为导向的腹腔镜下右半结肠切除术的最少病例数为21例，熟练掌握该术式后，其手术操作时间明显缩短，有良好的肿瘤根治效果。

关键词： 右半结肠癌；肠系膜上动脉；导向；学习曲线

Abstract：

Objective   To explore the learning curve of superior mesenteric artery-oriented laparoscopic right hemicolectomy, analyze the clinical and pathological data of patients in different learning stages, and provide references for the promotion of this operation. Method  The data of 54 cases of superior mesenteric artery-oriented laparoscopic right hemicolectomy performed by the same surgical team in the Department of General Surgery of Wujin Hospital Affiliated to Jiangsu University from February 2017 to December 2018 were retrospectively analyzed. The cumulative sum (CUSUM) method was used to fit the learning curve, and the patients were divided into the learning improvement stage group (the first 21 cases) and the proficiency stage group (the last 33 cases) according to the apex of the learning curve, and the effects of different stages on the clinical outcomes of the patients were analyzed. Result  The best fitting equation of the learning curve is: Y=0.008101X³-1.496X²+56.26X+38.33, and 21 was the minimum case number of operations needed to be accumulated to cross the learning curve. There were no statistically significant differences in the general datas between the learning improvement stage group and the proficiency stage group, such as gender, age, body mass index, while there were statistically significant differences in operation time and intraoperative blood loss (P＜0.05). There were statistically significant differences in the incidence of chylorrhea in postoperative complications between the two groups (P＜0.05), and no statistically significant differences were observed in postoperative pathology. Conclusion  The minimum number of cases in which surgeons with extensive experience in laparoscopic radical surgery for colorectal cancer mastered superior mesenteric artery-oriented laparoscopic right hemicolectomy was 21. Proficiency of the operation had a significantly shorter surgical operation time, which has a good radical tumor outcome.

Key Words:  Right colon cancer; Superior mesenteric artery; Orientation; Learning curve

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