Abstract:

Objective　The learning curve of peroral endoscopic pyloromyotomy is discussed by evaluating the surgical efficacy of this surgical approach in infant hypertrophic pyloric stenosis at different stages. Methods　The related data of 86 cases of peroral endoscopic pyloromyotomy performed by the same group of physicians in the digestive endoscopy center of Guangzhou First People's Hospital from August 2006 to June 2020 were analyzed, including 78 males and 8 females, with an age of 26-114 days old at admission, with the body weight of 2.12-6.10 kg. The cumulative sum (CUSUM) analysis method was used to draw the learning curve, with the highest point of the curve as the boundary, and the curve K value was negative till 30 cases. Therefore, the learning curve was crossed after the operation of 30 cases, and the study objects were divided into a pre-learning group (30 cases) and a post-learning group (56 cases). The differences in operation time, postoperative hospital stay, and postoperative feeding recovery time in different stages of the learning curve were compared, and the surgical effects in different stages were analyzed. Independent sample t test, χ² test, and Fisher exact probability method were used. Results　The peak of the curve was reached at 30 cases, and the slope of the curve decreased after a short plateau period. The operation time was (42.23±11.27) min in the pre-learning group and (21.73±6.50) min in the post-learning group, with a statistically significant difference (t=10.710, P<0.001). The postoperative hospital stay of the pre-learning group was (14.60±7.10) d, and the postoperative hospital stay of the post-learning group was (10.42±4.54) d, with a statistically significant difference (t=3.310, P=0.001). Conclusions　The learning curve for peroral endoscopic pyloromyotomy in the treatment of infant hypertrophic pyloric stenosis was calculated using the data from 30 cases. With the accumulation of surgical experience, the operation efficiency was gradually improved, and the operation time and length of hospital stay post-surgery were shortened.

Key words:

Hypertrophic pyloric stenosis, Pyloromyotomy, Peroral endoscopy, Learning curve

摘要：

目的　通过评估经口内镜幽门肌切开术治疗婴儿肥厚性幽门狭窄不同阶段的手术效果，讨论该手术方法的学习曲线。方法　分析广州市第一人民医院消化内镜中心2006年8月至2020年6月由同一组医师完成的86例经口内镜幽门肌切开手术相关资料，其中男78例，女8例，入院日龄26～114 d，入院体质量2.12～6.10 kg。采用累积求和分析法（CUSUM）绘制学习曲线，以曲线最高点为分界，30例时曲线K值为负，故手术达30例后跨越学习曲线，将研究对象分为学习前组（30例）和学习后组（56例）。比较学习曲线不同阶段的手术时间、术后住院时间、术后恢复喂养时间的差异，分析不同阶段的手术效果。采用独立样本t检验、χ²检验、Fisher确切概率法。结果　手术30例时达到曲线峰值，经过短暂的平台期后曲线斜率下降。学习前组手术时间为（42.23±11.27）min，学习后组手术时间为（21.73±6.50）min，差异有统计学意义（t=10.710，P<0.001）；学习前组术后住院时间（14.60±7.10）d，学习后组术后住院时间（10.42±4.54）d，差异有统计学意义（t=3.310，P=0.001）。结论　经口内镜幽门肌切开术治疗婴儿肥厚性幽门狭窄的学习曲线为30例，随着手术经验不断积累，手术效率逐渐提高，手术时间及术后住院时间缩短。

关键词:

肥厚性幽门狭窄, 幽门肌切开术, 经口内镜, 学习曲线