本文選題：腹腔鏡　切入點(diǎn)：左肝外葉切除術(shù)　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究探討本中心腹腔鏡左肝外葉切除術(shù)的學(xué)習(xí)曲線。資料和方法:回顧浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院自1999年6月至2016年8月完成的腹腔鏡左肝外葉切除手術(shù),收集和分析169例病例資料,全部手術(shù)均由同一醫(yī)生主導(dǎo)的肝膽胰外科團(tuán)隊(duì)實(shí)施。按照實(shí)施手術(shù)的時(shí)間先后,將169例患者依次排序并分別編號。收集患者的術(shù)前基礎(chǔ)資料,主要有性別、年齡、既往上腹部手術(shù)史、HBV感染病史、肝功能指標(biāo)、凝血功能、肝硬化病史、Child-Pugh分級、ASA評分等情況。術(shù)中資料包括手術(shù)時(shí)間、術(shù)中出血量、有無采取手助式,有無采取手術(shù)中轉(zhuǎn)開腹、肝門有無阻斷、術(shù)中有無輸血。收集術(shù)后并發(fā)癥情況、術(shù)后住院天數(shù)、術(shù)后病理良惡性結(jié)果等資料。通過計(jì)算手術(shù)時(shí)間和術(shù)中出血量的累積和,將原始數(shù)據(jù)的散點(diǎn)圖轉(zhuǎn)換為累積和散點(diǎn)圖,并認(rèn)為累積和的峰值代表數(shù)據(jù)趨于穩(wěn)定的起點(diǎn),以此作為依據(jù)將患者分成早期組和后期組。利用軟件(SPSS 20.0)進(jìn)行統(tǒng)計(jì)分析,比較早期組和后期組在手術(shù)用時(shí)、術(shù)中出血量、有無采取手助,手術(shù)中轉(zhuǎn)開腹比例、有無利用阻斷帶行肝門阻斷、有無術(shù)中輸血、術(shù)后并發(fā)癥病例和術(shù)后住院天數(shù)等參數(shù)的差異性。P0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果:學(xué)習(xí)曲線顯示經(jīng)過33例的腹腔鏡肝左肝外葉切除術(shù)訓(xùn)練后,術(shù)者完成該術(shù)式所需的時(shí)間達(dá)到穩(wěn)定期。學(xué)習(xí)曲線顯示手術(shù)出血在完成35例腹腔鏡肝左葉切除術(shù)后達(dá)到穩(wěn)定期。上述兩者在早期和后期的手術(shù)時(shí)間及術(shù)中出血均存在顯著差異。結(jié)論:本中心腹腔鏡下左外葉切除術(shù)的學(xué)習(xí)曲線大致為33-35例。鑒于腹腔鏡下左外葉切除相對操作方便、容易學(xué)習(xí),對于具備腹腔鏡基礎(chǔ)的微創(chuàng)外科醫(yī)生而言,腹腔鏡下左外側(cè)肝切除術(shù)是一種安全可行的手術(shù)方法。
[Abstract]:Objective: to study the learning curve of laparoscopic left extrahepatic lobectomy. Materials and methods: the laparoscopic left extrahepatic lobectomy was performed from June 1999 to August 2016 in run run run Shaw Hospital affiliated to Zhejiang University School of Medicine. The data of 169 cases were collected and analyzed, all of them were performed by the same doctor-led hepatobiliary and pancreatic surgery team. According to the time of operation, 169 patients were sequenced and numbered separately. The preoperative basic data of the patients were collected. Gender, age, previous history of upper abdominal surgery, history of HBV infection, liver function, coagulation function, liver cirrhosis history and Child-Pugh grade ASA score, etc. Whether or not the operation was converted to open surgery, whether the hepatic hilum was blocked or not, whether there was blood transfusion during the operation. The data of postoperative complications, postoperative hospital stay, pathological and malignant results were collected. By calculating the time of operation and the accumulative sum of blood loss during operation, The scattered plot of the original data is converted into the cumulative and scattered plot, and the peak value of the cumulative sum represents the starting point of data stabilization, which is used as the basis to divide the patient into early group and late group. The statistical analysis is carried out by using software SPSS 20.0). To compare the amount of blood loss during operation between the early group and the later group, whether the hands were taken, the proportion of the patients converted to laparotomy, whether to use the blocking band to block the hepatic hilus, and whether there was blood transfusion during the operation. Results: the learning curve showed that there were 33 cases of laparoscopic left lateral hepatic lobectomy after training. The learning curve showed that the operative bleeding was stable after laparoscopic hepatectomy in 35 cases. The operative time and intraoperative bleeding were both in the early and late stages. Conclusion: the learning curve of left lateral lobectomy under laparoscopy is approximately 33-35 cases. In view of the convenience of laparoscopic left lateral lobectomy, Easy to learn, laparoscopic left lateral hepatectomy is a safe and feasible procedure for minimally invasive surgeons with laparoscopic basis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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