目的:腹腔镜脾切除和食管胃血管离断术(LSED)是微创,有效,治疗门静脉高压症(PHT)的食管胃底静脉曲张破裂出血是安全的。该研究旨在通过累积求和(CUSUM)分析评估LSED的学习曲线。还检查了LSED和开放手术的10年随访数据。
方法:对五百九十四例患者进行回顾性分析。操作时间,术中失血,打开操作转换,选择术后并发症作为手术能力的评价指标。通过CUSUM方法评估LESD的学习曲线。患者特征,围手术期指标,并检查了10年的随访数据。
结果:共有236例患者接受了开放手术,358人接受了LSED。组间患者特征相似。LSED患者术中失血较少,并发症少,与开放手术队列相比,恢复更快。病例数为50时,LESD的学习曲线最大。两个阶段的术前一般特征具有可比性。但是熟练阶段减少了手术时间,减少失血,术后并发症少,与学习阶段相比,恢复更好。在10年的随访中,与接受开放手术的病例相比,LSED组的无复发出血生存率更高,总生存率更高。两组之间的游离肝癌发生率相似。
结论:掌握LSED程序需要约50例。与开放手术相比,LSED更安全,可行,和PHT患者的安全程序,与再出血率降低和总生存率提高相关。
OBJECTIVE: Laparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined.
METHODS: Five hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined.
RESULTS: Totally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups.
CONCLUSIONS: About 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival.