本文選題：腹腔鏡 + 肝切除��； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的：1.探討適用于臨床手術(shù)技能學(xué)習(xí)曲線的計(jì)算方法;2.研究探討腹腔鏡下肝左外葉切除及不規(guī)則肝切除的學(xué)習(xí)曲線。方法：回顧性收集、分析解放軍總醫(yī)院行腹腔鏡肝左外葉切除術(shù)和腹腔鏡下不規(guī)則肝切除術(shù)的患者資料,全部由同一術(shù)者領(lǐng)導(dǎo)的手術(shù)團(tuán)隊(duì)完成。排除臨床數(shù)據(jù)不完整的患者資料。將各部分研究入選的患者按照手術(shù)的先后順序排序、編號(hào)。收集患者的性別、年齡、Child-Pugh評(píng)分情況、手術(shù)時(shí)間、術(shù)中出血量、手術(shù)中轉(zhuǎn)情況、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥發(fā)生情況等指標(biāo)。將收集的數(shù)據(jù)的統(tǒng)計(jì)學(xué)處理分兩步進(jìn)行。①繪制手術(shù)時(shí)間標(biāo)準(zhǔn)差散點(diǎn)圖,并結(jié)合術(shù)中出血量和術(shù)后住院時(shí)間標(biāo)準(zhǔn)差散點(diǎn)圖確定組距并分組：②采用統(tǒng)計(jì)學(xué)軟件SPSS 20.0進(jìn)行統(tǒng)計(jì)。不同組別患者之間等級(jí)數(shù)據(jù)之間的差異(性別、Child-Pugh評(píng)分等級(jí)、手術(shù)中轉(zhuǎn)情況、術(shù)后并發(fā)癥發(fā)生情況)采用Pearsonχ2檢驗(yàn)進(jìn)行比較；不同組別之間定量數(shù)據(jù)的差異(年齡、手術(shù)時(shí)間、術(shù)中出血量、輸血量、術(shù)后住院時(shí)間)采用方差分析進(jìn)行比較,并利用LSD法進(jìn)行不同組別之間定量數(shù)據(jù)兩兩分析的比較,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果：腹腔鏡肝左外葉切除術(shù)的手術(shù)時(shí)間和術(shù)中出血量可在完成11例手術(shù)后趨于穩(wěn)定,術(shù)后住院時(shí)間可在完成21例后趨于穩(wěn)定；腹腔鏡下不規(guī)則肝切除的手術(shù)時(shí)間和術(shù)后住院時(shí)間可在完成30例手術(shù)實(shí)踐后達(dá)到趨于穩(wěn)定,術(shù)中出血量可在完成23例手術(shù)后趨于穩(wěn)定。結(jié)論：通過計(jì)算標(biāo)準(zhǔn)差峰值確定組距、分組的方法計(jì)算學(xué)習(xí)曲線可用于臨床實(shí)際情況。
[Abstract]:Purpose 1. To discuss the method of calculating the learning curve of clinical surgical skill. To study the learning curve of laparoscopic left lateral lobectomy and irregular hepatectomy. Methods: the data of patients undergoing laparoscopic left lateral lobectomy and laparoscopic irregular hepatectomy in PLA General Hospital were analyzed retrospectively. Exclude patients with incomplete clinical data. The patients who were selected in each study were ranked and numbered according to the order of operation. The patients' gender, age and Child-Pugh score, operative time, intraoperative blood loss, operation transfer, postoperative hospitalization time, postoperative complications and so on were collected. The statistical processing of the collected data was divided into two steps to draw the standard deviation scatter plot of operation time, and combined with the standard deviation scatter plot of intraoperative bleeding and postoperative hospitalization time, the group distance was determined and divided into two groups. The statistical software SPSS 20.0 was used to make the statistics. Pearson 蠂 2 test was used to compare the difference of grade data between different groups (gender Child-Pugh score, surgical transition, postoperative complications), and the difference of quantitative data (age, operation time, operation time) between different groups. Analysis of variance was used to compare the volume of blood loss, blood transfusion and hospital stay after operation, and the comparison of quantitative data between different groups by LSD method was statistically significant (P0.05). Results: the operative time and intraoperative bleeding volume of laparoscopic left lateral hepatic lobectomy were stable in 11 cases and hospital stay in 21 cases. The operative time and hospitalization time of laparoscopic irregular hepatectomy could be stable after 30 cases of operation practice, and the amount of intraoperative bleeding could be stable after 23 cases of operation. Conclusion: the group distance is determined by calculating the peak value of standard deviation, and the learning curve can be used in clinical practice.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3

【共引文獻(xiàn)】

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本文編號(hào)：1990140