Learning curve for performing choledochotomy bile duct exploration with primary closure after laparoscopic cholecystectomy
Learning curve for performing choledochotomy bile duct exploration with primary closure after laparoscopic cholecystectomy
复制标题
腹腔镜胆囊切除术后进行胆总管切开术和一期闭合胆管探查的学习曲线
DOI：
10.1007/s00464-018-6175-3
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发表时间：
2018-10-01
影响因子：
3.1
通讯作者：
Shao, Jianghua
中科院分区：
文献类型：
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作者：
Zhu, Hengqing;Wu, Linquan;Shao, Jianghua
背景腹腔镜胆囊切除术（LC）和腹腔镜胆总管探查术（LCBDE）后一期缝合是治疗胆囊结石合并胆总管结石安全有效的方法。本研究的目的是评估LC+LCBDE后进行一期缝合的学习曲线。方法我们回顾性地确定了2009年1月至2015年4月在我们机构由一名外科医生进行LC+LCBDE后进行一期缝合的所有患者，并分析了术前，术中，和术后数据使用累积总和（AUCUM）分析，以评估学习曲线为这个proceeding.ResultsOverall，有390例患者。术后并发症发生率为7.2%，其中胆漏9例（2.3%），胆总管结石残留3例（0.8%）。最佳模拟公式为：UMOT = 312.209 ×程序0.599 × e（−0.011×程序）+ 122.608（R2= 0.96）。学习曲线由两个阶段组成，第1阶段（最初的54例患者）和第2阶段（剩余的336例患者）。两个阶段之间观察到OT（116.8 ± 22.4 vs. 93.8 ± 17.8 min;p< 0.001）和并发症发生率（16.7 vs. 5.7%;p< 0.01）显著降低，包括胆漏发生率（7.4 vs. 1.5%;p< 0.01）和结石残留率（3.7 vs. 0.3%;p< 0.01）。此外，20例患者转为开放手术。嵌顿结石与转换独立相关，如由多变量analysis.ConclusionThe数据表明，学习曲线的这个过程中实现了约54例。嵌顿结石是影响转化率的唯一风险因素。
BackgroundPrimary closure after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) is a safe and effective approach for treating cholecystolithiasis with choledocholithiasis. The aim of this study was to evaluate the learning curve of performing primary closure after LC+LCBDE.MethodsWe retrospectively identified all patients who underwent primary closure after LC+LCBDE performed by a single surgeon from January 2009 to April 2015 in our institution, and analyzed preoperative, intraoperative, and postoperative data using the cumulative sum (CUSUM) analysis to evaluate the learning curve for this procedure.ResultsOverall, there were 390 patients. The total postoperative complications rate was 7.2%, including bile leakage in 9 (2.3%) patients and retained common bile duct stone in 3 (0.8%) patients. The CUSUM operating time (OT) learning curve was best modeled by the equation: CUSUMOT= 312.209 × procedure0.599× e(−0.011×procedure)+ 122.608 (R2= 0.96). The learning curve was composed of two phases, phase 1 (the initial 54 patients) and phase 2 (the remaining 336 patients). A significant decrease in the OT (116.8 ± 22.4 vs. 93.8 ± 17.8 min;p< 0.001) and complication rate (16.7 vs. 5.7%;p< 0.01) including the rate of bile leakage (7.4 vs. 1.5%;p< 0.01) and retained stone (3.7 vs. 0.3%;p< 0.01) was observed between the two phases. In addition, 20 patients had conversion to open surgery. Impacted stones were independently associated with conversion, as indicated by a multivariable analysis.ConclusionThe data suggest that the learning curve of this procedure was achieved in approximately 54 cases. An impacted stone was the only risk factor that affected the conversion rate.