摘要
目的:探讨达芬奇机器人三臂四孔法在儿童肾盂输尿管成形术中的学习曲线,为相关手术的开展及术者培训提供参考。方法:回顾性分析2020年5月—2022年11月在上海儿童医学中心贵州医院由同一名主刀医生采用达芬奇机器人三臂四孔法完成的儿童肾盂输尿管成形术病例资料。记录每例手术的相关指标,包括手术时间、肾盂输尿管连接部吻合时间、术中出血量、术后住院时间等。采用累积和分析法(cumulative sum method,CUSUM)对手术时间和肾盂输尿管连接部吻合时间进行学习曲线分析,以确定学习曲线的阶段及完成学习所需的最低手术例数。结果:共纳入100例患儿,手术均顺利完成,无中转开放手术。随着手术例数的增加,手术时间和肾盂输尿管连接部吻合时间逐渐缩短。通过CUSUM分析,发现学习曲线在完成17例手术后趋于平稳,此例数即为完成学习曲线所需的最低手术例数。在学习曲线的不同阶段,除手术时间和吻合时间外,其他观察指标如术中出血量、术后住院时间等差异无统计学意义。结论:达芬奇机器人在儿童肾盂输尿管成形术中存在明显的学习曲线,术者在完成一定例数的手术后,手术操作效率显著提高。对于计划开展此项技术的医疗团队,应重视学习曲线的影响,合理安排手术量及培训计划,以确保手术的安全性和有效性。
Objective:To explore the learning curve of the da Vinci robot-assisted three-arm four-port approach in pediatric pyeloureteroplasty,and to provide references for the implementation of related surgeries and the training of surgeons.Methods:A retrospective analysis was performed on the clinical data of pediatric patients who underwent Da Vinci robot-assisted three-arm four-port pyeloureteroplasty conducted by the same chief surgeon at Guizhou Hospital of Shanghai Children’s Medical Center from May 2020to November 2022.Relevant surgical indicators of each case were recorded,including operation time,ureteropelvic junction obstruction(UPJO)anastomosis time,intraoperative blood loss,and postoperative hospital stay.The cumulative sum method(CUSUM)was applied to analyze the learning curves of operation time and UPJO anastomosis time,so as to determine the stages of the learning curve and the minimum number of surgeries required to complete the learning process.Results:A total of 100children were included,and all surgeries were successfully completed without conversion to open surgery.With the increase in the number of surgeries,both operative time and ureteropelvic junction anastomosis time gradually decreased.CUSUM analysis showed that the learning curve stabilized after 17surgeries,which was the minimum number of surgeries required to complete the learning curve.At different stages of the learning curve,except for operative time and anastomosis time there were no statistically significant differences in other observed indicators such as intraoperative blood loss or postoperative hospital stay.Conclusion:Da Vinci robot-assisted pediatric pyeloureteroplasty has a significant learning curve.Surgeons show significantly improved surgical efficiency after completing a certain number of surgeries.For medical teams planning to carry out this technology,attention should be paid to the impact of the learning curve,and the number of surgeries and training programs should be reasonably arranged to ensure the safety and effectiveness of the surgery.
作者
唐虹宇
裴军
曾荣阳
吴谋东
彭金普
安妮妮
TANG HongyuPEI Jun;ZENG Rongyang;WU Moudong;PENG Jinpu;AN Nini(Department of Pediatric Urology,Shanghai Children’s Medical Center GuiZhou Hospital,Shanghai Jiao Tong University School of Medicine,Guiyang,550081,China;Department of Pediatric Surgery,Guizhou Provincial People’s Hospital;Guizhou Medical University)
出处
《临床泌尿外科杂志》
2025年第11期978-982,共5页
Journal of Clinical Urology
基金
2025年贵州省卫生健康委省级医学重点学科建设项目经费资助。
