腹腔镜Nissen胃底折叠术学习曲线的研究：采用累积和（CUSUM）法及多元回归分析聚焦神经肌肉疾病患者的手术时间

文献信息

中文摘要

目的： 达到腹腔镜Nissen胃底折叠术（Lap-Nissen）熟练程度所需病例数仍不明确。我们采用累积和（CUSUM）法分析手术时间以构建学习曲线并估计所需病例量。
方法： 我们回顾性分析了自2008年10月起在本机构接受Lap-Nissen的患者。使用CUSUM分析构建每位外科医生的学习曲线，并通过分段线性回归分为三个阶段（I-III）。
结果： 共分析109例。对于外科医生A（n = 46），平均手术时间在各阶段下降：I期（第1-8例，299.4分钟）、II期（第9-32例，217.7分钟）和III期（第33-46例，179.6分钟）。外科医生B（n = 42）观察到类似趋势：I期（第1-5例，328.2分钟）、II期（第6-30例，204.4分钟）和III期（第31-42例，179.5分钟）。外科医生C（n = 14）未呈现明确的学习曲线，外科医生D-F因病例数少而被排除。多元回归分析确定外科医生的经验是与手术时间相关的最强因素（β = -0.53，p < 0.001）。
结论： I期约包括5例，而II期包括超过30例。有必要开展更大规模的多中心前瞻性研究。

英文摘要

PURPOSE: The number of cases necessary to achieve proficiency in laparoscopic Nissen fundoplication (Lap-Nissen) remains unclear. We analyzed operative times using the cumulative sum (CUSUM) method to construct learning curves and estimate the required case volume.
METHODS: We retrospectively reviewed patients who underwent Lap-Nissen at our institution beginning in October 2008. Learning curves for each surgeon were constructed using CUSUM analysis and divided into three phases (I-III) by piecewise linear regression.
RESULTS: A total of 109 cases were analyzed. For surgeon A (n = 46), the mean operative time decreased across phases I (cases 1-8, 299.4 min), II (9-32, 217.7 min), and III (33-46, 179.6 min). Similar trends were observed for surgeon B (n = 42): I (1-5, 328.2 min), II (6-30, 204.4 min), and III (31-42, 179.5 min). Surgeon C (n = 14) delivered no clear learning curve, and surgeons D-F were excluded due to low case numbers. Multiple regression analysis identified the surgeons' experience as the strongest factor associated with operative time (β = - 0.53, p < 0.001).
CONCLUSION: Phase I comprised approximately five cases, while phase II included more than 30 cases. Larger multicenter prospective studies are warranted.