专家规范化指导对基层医院腹腔镜胰十二指肠切除术学习曲线的影响

The Impact of Standardized Expert Guidance on the Learning Curve for Laparoscopic Pancreaticoduodenectomy in Community Hospitals

摘要: 目的：探讨专家规范化指导对基层医院开展腹腔镜胰十二指肠切除术学习曲线的影响。方法：回顾性分析2020年4月至2024年6月阜阳市人民医院连续50例TLPD患者资料。根据CUSUM学习曲线模型分为三期：初始高效期(n = 15)、调整波动期(n = 15)、稳定成熟期(n = 20)。比较三组术中指标(手术时间、出血量、中转开腹率)、术后恢复(引流时间、住院天数)及并发症(B/C级胰瘘、胆瘘、出血)。结果：三组术前基线资料无统计学差异(P > 0.05)。从初始期至成熟期，经过专家指导后，手术时间(491.9 ± 31.5 min vs. 406.3 ± 18.5 min)和术中出血量(138.7 [50, 300] mL vs. 83.5 [50, 100] mL)显著下降(P < 0.05)。成熟期B/C级胰瘘发生率较初始期降低(5.0% vs. 13.3%)，术后住院时间缩短(19.6 ± 9.4 d vs. 12.3 ± 3.1 d)。结论：专家现场规范化指导通过优化钩突解剖、胰肠吻合等关键技术，显著缩短TLPD学习曲线，提高手术安全性，为基层医院开展复杂腹腔镜手术提供可行性路径。

Abstract: Objective: To investigate the impact of standardized expert guidance on the learning curve for laparoscopic pancreatoduodenectomy (TLPD) in a primary hospital setting. Methods: A retrospective analysis was conducted on 50 consecutive patients who underwent TLPD at Fuyang People’s Hospital from April 2020 to June 2024. Based on the cumulative sum (CUSUM) learning curve model, patients were divided into three phases: initial proficiency phase (n = 15), adjustment and fluctuation phase (n = 15), and stable mastery phase (n = 20). Intraoperative indicators (operative time, estimated blood loss, conversion to open surgery rate), postoperative recovery (duration of drainage, length of hospital stay), and complications (grade B/C pancreatic fistula, biliary fistula, hemorrhage) were compared among the three groups. Results: No statistically significant differences were observed in preoperative baseline characteristics among the three groups (P > 0.05). From the initial to the mastery phase, following expert guidance, operative time (491.9 ± 31.5 min vs. 406.3 ± 18.5 min) and intraoperative blood loss (138.7 [50, 300] mL vs. 83.5 [50, 100] mL) significantly decreased (P < 0.05). The incidence of grade B/C pancreatic fistula was lower in the mastery phase compared to the initial phase (5.0% vs. 13.3%), and postoperative hospital stay was shorter (19.6 ± 9.4 days vs. 12.3 ± 3.1 days). Conclusion: Standardized on-site expert guidance, by optimizing key techniques such as uncinate process dissection and pancreaticojejunostomy, significantly shortens the TLPD learning curve and enhances procedural safety, providing a feasible pathway for primary hospitals to implement complex laparoscopic surgeries.