Shinohara Toshihiko, Fujita Tetsuji, Misawa Takeyuki, Sakamoto Taro, Yoshida Kazuhiko, Kashiwagi Hideyuki, Yanaga Katsuhiko
Department of Surgery, The Jikei University School of Medicine, Nishi-shinbashi, 3-25-8, Minato-ku, Tokyo, 105-8461, Japan.
Langenbecks Arch Surg. 2009 May;394(3):557-62. doi: 10.1007/s00423-008-0411-6. Epub 2008 Aug 28.
The purpose of this study was to evaluate the long-lasting influence of laparoscopic training during residency course on outcomes of laparoscopic cholecystectomy (LC).
We compared outcomes of LC in patients treated by surgeons who have learned LC by the traditional surgical residency program (traditional group; n = 15) with those of LC operated on by surgeons who received additional intensive laboratory training in their residency [Jikei Surgical Skill Training Program (JSTP) group; n = 9].
Among the 503 patients subjected to LC, 302 (60.0%) cases were performed by surgeons in the traditional group and 201 (40.0%) cases in the JSTP group. The patient characteristics, operative outcome variables, and the pathological findings of the gallbladder were comparable in the two groups. Despite no difference in the above factors, conversion rates were significantly higher in the traditional group compared with the JSTP group (10.6% vs 5.0%; p = 0.026). In multivariate analysis, training background was an independent risk factor for conversion to open surgery (odds ratio, 2.79; 95% confidence interval, 1.25-6.24).
To ensure competence for laparoscopic skills, we propose that such training program should be integrated into the curriculum of the general surgery residency.
本研究旨在评估住院医师培训期间腹腔镜训练对腹腔镜胆囊切除术（LC）手术效果的长期影响。
我们比较了通过传统外科住院医师培训项目学习LC的外科医生治疗的患者（传统组；n = 15）与在住院医师培训期间接受额外强化实验室训练的外科医生进行LC手术的患者（东京慈惠会医科大学外科技能培训项目（JSTP）组；n = 9）的LC手术效果。
在接受LC手术的503例患者中，传统组外科医生进行了302例（60.0%），JSTP组进行了201例（40.0%）。两组患者的特征、手术结果变量和胆囊病理检查结果具有可比性。尽管上述因素无差异，但传统组的中转率显著高于JSTP组（10.6%对5.0%；p = 0.026）。多因素分析显示，培训背景是转为开腹手术的独立危险因素（比值比，2.79；95%置信区间，1.25 - 6.24）。
为确保腹腔镜技能的能力，我们建议将此类培训项目纳入普通外科住院医师培训课程。
