基于 CUSUM 分析的腹腔镜宫颈癌根治术学习曲线与围手术期并发症的回顾性分析

A retrospective study of the learning curve and perioperative complications of laparoscopic radical hysterectomy for cervical cancer based on CUSUM analysis

摘要

目的 探讨手术学习曲线对腹腔镜宫颈癌根治术并发症及术中关键指标的影响，分析手术学习曲线与术后并发症发生的关联，为该手术的质量控制及术者的培训提供理论参考。方法 选取山东大学齐鲁第二医院同一术者(主任医师)主刀的102例早期宫颈癌行腹腔镜下宫颈癌根治术的患者，按手术时间采用累积和(cumulative sum, CUSUM)分析法拟合学习曲线，分为两阶段(前29例为学习曲线成长阶段，后73例为成熟阶段)，比较两阶段手术相关指标及术后并发症发生情况并进行统计分析。结果 学习曲线的最佳拟合方程为CUSUM_n=-117.850+89.4n-1.759n²+0.009n³(R²=0.956，P＜0.05)，拟合曲线良好，计算出成长阶段为前29例，后73例为成熟阶段。相较于成长阶段，成熟阶段手术时间更短、术中出血量更少，组间差异具有统计学意义(P＜0.05)。对比成长与成熟两个阶段的术中术后并发症(如术中器官损伤、淋巴囊肿、感染、输尿管狭窄等)发生率差异无统计学意义(均P＞0.05)。结论 CUSUM分析表明，经过29例的手术积累，术者可稳定掌握该手术技术；随着手术学习曲线由成长阶段过渡到成熟阶段，手术的出血量更少，手术时间更短，术中术后并发症相当。

Abstract

Objective To investigate the impact of surgical learning curves on complications and intraoperative key indicators after laparoscopic radical hysterectomy for women with cervical cancer. and to analyze, the association between the surgical learning curve and postoperative complications, so as to provide a theoretical reference for quality control and surgeon training. Methods A total of 102 patients who were diagnosed with early-stage cervical cancer and underwent laparoscopic radical hysterectomy were enrolled in the study. All patients were operated on by the same senior surgeon (chief physician) at the Second Qilu Hospital of Shandong University. Cumulative sum (CUSUM) analysis based on operative time was applied to model the learning curve, dividing the cases into two phases: the learning phase (the first 29 cases) and the mastery phase (the subsequent 73 cases). Intraoperative parameters and postoperative complication rates were then compared between these two phases. Results The optimal CUSUM fitting equation was CUSUM_n=-117.850+89.4n-1.759n²+0.009n³( R² =0.956, P＜0.05), indicating a strong model fit. Based on this model, the learning phase was attributed to the first 29 cases, while the subsequent 73 cases constituted the mastery phase. In the mastery phase, operative time and intraoperative blood loss were significantly reduced compared to the learning phase (P＜0.05). However, there were no statistically significant differences between the two phases in the incidence of intraoperative or postoperative complications (including organ injury, lymphocysts, infections, and ureteral stenosis) (P＞0.05). Conclusion CUSUM analysis showed that the surgeon became technically stable after performing around 29 cases. As the learning curve transitioned from the growth phase to the mastery phase, the operative efficiency improved, with shorter surgery times and reduced blood loss. Meanwhile, the rates of intraoperative and postoperative complications remained comparable.

关键词

腹腔镜宫颈癌根治术 / 并发症 / 手术学习曲线 / 早期宫颈癌 / 回顾性分析 / 累积和分析

Key words

Laparoscopic radical hysterectomy for cervical cancer / Complications / Surgical learning curve / Early-stage cervical cancer / Retrospective analysis / Cumulative sum analysis

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