摘要目的 探讨腹腔镜辅助下高位肛门闭锁肛门成形术的学习曲线.方法 回顾性分析首都儿科研究所2008年12月至2015年10月由同一医师主刀完成的60例腹腔镜辅助下高位肛门闭锁肛门成形术的相关临床资料.按手术实施的顺序(即时间顺序),将所收集到的符合标准的病例分为4组,每组15例.对比各组之间的临床资料(手术时间、术中出血量、中转开腹率、术中输血率、术后并发症及术后患儿住院时间)的差异.结果 A组手术平均时间(176.3±41.6) min,B组(128.8±36.1)min,C组(127.3 ±35.2) min,D组(124.0±30.1) min,4组手术时间呈递减趋势.A组手术时间显著长于B、C、D组,差异有统计学意义(P＜0.05),A组与B组比较差异有统计学意义(P＜0.05).A组出血量明显多于B、C、D组[A组(17.5±6.5)mL,B组(15.0±5.0)mL,C组(14.5±5.5)mL,D组(8.5±6.5)mL],4组间差异有统计学意义(P＜0.05),平均出血量为12.7 mL.研究中患儿的术后并发症出现率、总住院时间、输血率、术后住院时间之间差异无统计学意义(P＞0.05).统计数据由A组的平均住院日9.8d缩减到D组的7.4d.结论 对于拥有良好外科基础的外科医师来说,腹腔镜辅助下高位肛门闭锁肛门成形术约15例后,手术可达到较为熟练的程度.

abstractsObjective To investigate the learning curve of laparoscopy-assisted anorectoplasty in the treatment of high imperforate anus.Methods Sixty patients with high congenital anal atresia who were treated with laparoscopy-assisted anorectoplasty in the Capital Institute of Pediatrics from December 2008 to October 2015 by one experience surgeon were selected as observation group.Based on the criteria,the patients were divided into 4 groups(15 cases in each group) according to the sequence of the operation and every 15 cases served as a learning phase.The operating time,frequency of operation,complication rate,conversion rate to open surgery,blood loss,the rates of blood transfusion and hospital stay were compared among the 4 phases.Results The mean operation duration was (176.3 ±41.6) min,(128.8 ± 36.1) min,(127.3 ± 35.2) min,(124.0 ± 30.1) min in group A,B,C and D,respectively.The operation duration of 4 groups showed a declining trend.Group A has longer operation time than group B,C and D,the difference were statistically significant (P ＜ 0.05).In detail,the comparison of operation time between group A and group B was statistically significant (P ＜ 0.05).Furthermore,group A had significantly more median blood loss than group B,C and D,the differences were statistically significant [the 4 groups of data,respectively,group A:(17.5 ±6.5) mL,group B:(15.0±5.0) mL,group C:(14.5 ±5.5) mL,group D:(8.5 ±6.5) mL,P＜0.05].The mean capacity of blood loss was 12.7 mL.No significant difference was found in surgical complications,the rates of blood transfusion,total hospital stay,and postoperative hospital stay among the 4 groups(P ＞ 0.05).But the postoperative hospital stay decreased from 9.8 d (group A) to 7.4 d (group D).Conclusions For a well-trained surgeon in imperforate anus surgery.The learning curve of laparoscopy-assisted anorectoplasty in the treatment of high imperforate anus on about 15 cases helps to make a skillful surgeon.