Teoh A Y B, Chong C N, Wong J, Lee K F, Chiu P W Y, Ng S S M, Lai P B S
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
Br J Surg. 2007 Sep;94(9):1128-32. doi: 10.1002/bjs.5777.
The aim of this retrospective review was to assess the clinical outcomes of laparoscopic cholecystectomy for acute cholecystitis since the conclusion of a randomized controlled trial in 1997.
Records of all patients admitted for acute cholecystitis in whom early laparoscopic cholecystectomy was attempted between July 1997 and December 2004 were reviewed.
A total of 209 patients were recruited to this study. Forty-three surgeons performed the procedures. The conversion rate increased significantly in the early period after the trial from 21 per cent to 42 per cent (39 of 92 patients) and decreased significantly to 24 per cent (13 of 54 patients) in the later period. The proportion of operations performed by higher surgical trainees increased significantly from 17 per cent in the early period to 56 per cent in the later period. This increase was associated with a fall in conversion rate without any significant increase in duration of operation or complication rate.
This study has demonstrated that the results achieved in a randomized trial can be translated into clinical practice by the entire surgical unit. A structured training programme with the inclusion of an experienced surgeon assisting both trainees and specialists should minimize this learning curve.
本次回顾性研究的目的是评估自1997年一项随机对照试验结束以来，腹腔镜胆囊切除术治疗急性胆囊炎的临床疗效。
回顾了1997年7月至2004年12月期间所有因急性胆囊炎入院且尝试早期腹腔镜胆囊切除术患者的记录。
本研究共纳入209例患者。43名外科医生实施了手术。试验早期的中转率从21%显著升至42%（92例患者中有39例），后期又显著降至24%（54例患者中有13例）。高年资外科住院医师实施手术的比例从早期的17%显著增至后期的56%。这一增长与中转率下降相关，而手术时长或并发症发生率均无显著增加。
本研究表明，整个外科团队可将随机试验的结果应用于临床实践。纳入经验丰富的外科医生辅助住院医师和专科医生的结构化培训计划应能最大程度缩短这一学习曲线。
