Koulas S G, Tsimoyiannis J, Koutsourelakis I, Zikos N, Pappas-Gogos G, Siakas P, Tsimoyiannis E C
Department of Surgery, General Hospital of Ioannina 'G. Hatzikosta', Ioannina, Greece.
JSLS. 2006 Oct-Dec;10(4):484-7.
The aim of this study was to assess morbidity, mortality, and outcome in select patients after laparoscopic cholecystectomy performed by consultants or by Specialist Registrars (SpRs) and Senior House Officers (SHO), in the General Hospital of Ioannina 'G. Hatzikosta' in northwestern Greece.
Between January 1, 2001 and December 31, 2005, 1370 laparoscopic cholecystectomies were performed, 445 (33%) by SpRs and SHO and 925 (67%) by consultants. Patients included 982 (71.3%) women and 388 (28.7%) men. The mean age was 46.2 years (range, 17 to 79). All patients had routine blood tests (including liver function tests), electrocardiography, chest x-ray, and abdominal ultrasound scan performed preoperatively. All patients received a general anesthesia, and the standard Reddick and Olsen technique was performed. The Harmonic scalpel was used in all cases.
Four conversions (0.3%) were required to an open procedure, (2 in the SpRs and SHO group and 2 in the group of consultants), because of impossible recognition of anatomy around Calot's triangle. The mean operative time was 57 minutes (range, 33 to 97) for SpRs and SHO, while for the consultants it was 49 minutes (range, 27 to 78, P=0.25). Mortality rate was 0% in both groups. There were 44 major complications (2.7%), 17 in the SHO and SpRs group (3.7%) and 27 in the consultant group (1.7%, P=0.11). The complications included bowel thermal injury (consultants [cons], 1; residents [res], none); bile duct injury (cons, 1; res, none); bile leak (cons, 3; res, 5); hemorrhage (cons, 2; res, 2); hematomas at the trocar sites (cons, 5; res, 4); inflammation of the port site at the umbilicus (cons, 4; res, 5); paralytic ileus (cons, 4; res, 3); and hemorrhage from the subxiphoid trocar (cons, 2; res, 3), which stopped spontaneously. The mean hospital stay was 1.3 days, while all the patients resumed their normal activities after 11.7 days (range, 7 to 19).
Supervised laparoscopic cholecystectomy performed by trainees does not increase surgical morbidity and does not compromise surgical outcome.
本研究旨在评估在希腊西北部约阿尼纳“G. 哈齐科斯塔”综合医院，由顾问医师或专科住院医师（SpRs）及高年资住院医师（SHO）实施的腹腔镜胆囊切除术后特定患者的发病率、死亡率及手术效果。
在2001年1月1日至2005年12月31日期间，共进行了1370例腹腔镜胆囊切除术，其中445例（33%）由SpRs及SHO实施，925例（67%）由顾问医师实施。患者包括982例（71.3%）女性和388例（28.7%）男性。平均年龄为46.2岁（范围17至79岁）。所有患者术前均进行了常规血液检查（包括肝功能检查）、心电图、胸部X线及腹部超声扫描。所有患者均接受全身麻醉，并采用标准的雷迪克和奥尔森技术。所有病例均使用了超声刀。
因无法辨认胆囊三角周围解剖结构而需转为开腹手术4例（0.3%），（SpRs及SHO组2例，顾问医师组2例）。SpRs及SHO组平均手术时间为57分钟（范围33至97分钟），而顾问医师组为49分钟（范围27至78分钟，P = 0.25）。两组死亡率均为0%。共有44例主要并发症（2.7%），SpRs及SHO组17例（3.7%），顾问医师组27例（1.7%，P = 0.11）。并发症包括肠道热损伤（顾问医师组[cons]，1例；住院医师组[res]，无）；胆管损伤（cons组，1例；res组，无）；胆漏（cons组，3例；res组，5例）；出血（cons组，2例；res组，2例）；套管针穿刺部位血肿（cons组，5例；res组4例）；脐部穿刺孔炎症（cons组，4例；res组，5例）；麻痹性肠梗阻（cons组，4例；res组3例）；剑突下套管针出血（cons组，2例；res组，3例），均自行停止出血。平均住院时间为1.3天，并在11.7天（范围7至19天）后恢复正常活动。
由实习医生在监督下实施的腹腔镜胆囊切除术不会增加手术发病率，也不会影响手术效果。
