Ayerdi J, Wiseman J, Gupta S K, Simon S C
Department of Surgery, Robert Packer Hospital/Guthrie Clinic, Sayre, Pennsylvania, USA.
Am Surg. 2001 Aug;67(8):780-5.
The present study reports findings concerning the impact of the learning environment on the conversion rate of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). At Metro-West Medical Center (Framingham, MA) seven surgeons performed 866 LCs between 1990 and 1995. Group I consisted of three surgeons who learned the procedure as part of their General Surgery Residency training, whereas the remaining four surgeons representing Group II learned the procedure through private courses. We emphasize the importance of the surgeons' training background on the conversion rates, operative times, and length of hospitalization for patients undergoing LC. The conversion rates, operative times, and complication rates were analyzed with and without a 2-year period of adjustment to compensate for the learning curve of early procedures. Operative times and conversion rates from LC to OC were lower for cases done by surgeons from Group I, even when the learning curve was corrected. The complication rates were higher for surgeons in Group II, but this did not reach statistical significance. As surgeons from Group II gained more experience their operation times and conversion rates decreased. However, there still was a statistically significant difference in favor of surgeons who learned the procedure as part of a structured curriculum. These data suggest a long-lasting influence of the learning environment on the conversion rates and operative times.
本研究报告了有关学习环境对腹腔镜胆囊切除术（LC）转为开腹胆囊切除术（OC）转化率影响的研究结果。在西地铁医疗中心（马萨诸塞州弗雷明汉），1990年至1995年间，7名外科医生共进行了866例LC手术。第一组由3名外科医生组成，他们在普通外科住院医师培训期间学习了该手术，而代表第二组的其余4名外科医生则通过私人课程学习了该手术。我们强调外科医生的培训背景对接受LC手术患者的转化率、手术时间和住院时间的重要性。在有和没有2年调整期以补偿早期手术学习曲线的情况下，对转化率、手术时间和并发症发生率进行了分析。即使校正了学习曲线，第一组外科医生所做病例的手术时间和从LC转为OC的转化率仍较低。第二组外科医生的并发症发生率较高，但未达到统计学显著性。随着第二组外科医生经验的增加，他们的手术时间和转化率降低。然而，对于在结构化课程中学习该手术的外科医生，仍存在统计学上的显著优势。这些数据表明学习环境对转化率和手术时间有长期影响。
