- 期刊
The Learning Curve of Laparoscopic Colorectal Surgery in Regional Hospital
地區醫院的腹腔鏡大腸直腸手術之學習曲線
摘要
目的 自1990年起，腹腔鏡大腸直腸手術以廣泛應用在良性及惡性的大腸直腸病變上。然而鮮少有文獻討論關於地區醫院的腹腔鏡大腸直腸手術之學習曲線。本篇研究目的是要分享於地區醫院發展腹腔鏡大腸直腸手術的一些經驗及結果。 方法 兩位之前沒有腹腔鏡大腸直腸手術經驗的直腸專科醫師於2008年八月至2009年一月實行30例腹腔鏡大腸直腸手術，比較前15例（A組）和後15例（B組）病患之術前資料（年紀，男女比例，手術難度）及早期術後結果（如：手術時間，術中出血量，是否尋求其他醫師協助，有無併發症，是否改成傳統剖腹手術）。根據術中經驗和術後結果觀察手術之學習曲線。 結果 A組和B組病患就實行手術方式，男女比例，手術難度方面沒有差距。與A組病患比較，B組病患手術時間較短，較早恢復腸道功能，出血量較少，住院天數較短，但這些數值均無達到顯著意義。有顯著意義方面有：B組病患年紀較高，尋求醫師協助比例較少。兩組病患發生併發症比例相同，但A組有一位病患須改成傳統剖腹手術。手術時間及術中出血量隨經驗累積均漸漸減少，於第16位病患後趨於穩定。 結論 有良好腹腔鏡基礎（腹腔鏡膽囊切除術和腹腔鏡闌尾切除術）的大腸直腸專科醫師，在有經驗的腹腔鏡大腸直腸手術醫師的協助之下，可在地區醫院安全的實行腹腔鏡大腸直腸手術。腹腔鏡大腸直腸手術的學習曲線於第16 位病患達到成熟期。
並列摘要
Purpose. In the early 1990s, laparoscopic colon surgery was shown to be technically feasible and was applied to managing benign and malignant colon disease. Few published discussions describe the learning curve for performing this procedure in regional hospital. Here we present our surgical experience and early outcomes for laparoscopic colorectal resection. Methods. Our laparoscopic surgical team comprised well trained colorectal surgeons without prior experience performing laparoscopic colorectal surgery. From August 2008 to January 2009, we performed 30 laparoscopic colorectal surgeries. Two equal, consecutive groups, the first 15 cases (group A) and later 15 cases (group B), were retrospectively reviewed. Patient demographics, perioperative parameters and early outcomes (i.e., operative times, blood loss, length of stay, need for technique assistance, complications, conversion to open surgery) were recorded. Surgical experience and outcomes were analyzed to document our learning curve. Results. No significant differences were found between groups in surgical procedures, gender ratios and difficulty of operative procedures. Group B had shorter operative times, earlier recovery of gastrointestinal function, less blood loss, and shorter hospital stays without significant differences. Significant differences between groups included higher ages in group B and higher incidence of calls for technical assistance in group A. The groups' complication rates were identical. Group A had the only case of conversion to open surgery. Operation times and blood loss decreased significantly after case 16. Conclusions. Laparoscopic colorectal resection can be performed safely in regional hospital. Assistance from a surgeon experienced in laparoscopic colorectal resection helped, colorectal surgeons with laparoscopic experienced (laparoscopic cholecystectomy and laparoscopic appendectomy) achieve proficiency at 16 cases.