Bencini Lapo, Bernini Marco, Martini Francesco, Rossi Michele, Tommasi Cinzia, Miranda Egidio, Sanchez Luis Josè, Naspetti Riccardo, Manetti Roberto, Ferrara Angelo, Nesi Silvia, Boffi Bernardo, Farsi Marco, Moretti Renato
Department of Oncology, Careggi Main Florence University and Regional Hospital, Italy.
JSLS. 2009 Jul-Sep;13(3):391-7.
Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons.
Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications.
The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P<0.001) than patients did operated on by experienced surgeons.
Surgical residents performed more emergency laparoscopic appendectomies on foreign patients suffering from intermediate to severe diseases compared with experienced surgeons, with comparable surgical outcomes and lower conversion rates.
腹腔镜阑尾切除术在外科住院医师中广泛开展，但其适应证的变化及手术效果尚未得到充分研究。本研究旨在探讨住院医师与经验丰富的外科医生实施的腹腔镜阑尾切除术在适应证和手术效果方面是否存在差异。
1999年至2007年间，共实施并记录了218例腹腔镜阑尾切除术。分析数据，比较住院医师与经验丰富的外科医生实施的手术在手术适应证和疾病严重程度方面的差异。此外，还对腹腔镜阑尾切除术的手术效果和并发症进行了全面比较。
与经验丰富的外科医生相比，住院医师实施腹腔镜阑尾切除术时中转开腹的比例较低（8%对17%，P = 0.04），并发症发生率相近（12%对13%，P = 0.16）。中位手术时间也相当（67分钟对60分钟，P = 0.23）。然而，与经验丰富的外科医生所做手术的患者相比，住院医师所做手术的患者中有更多急诊手术（86%对70%，P = 0.009），包括更多外国患者（27%对15%，P = 0.03），且患有中重度疾病的比例更高（81%对52%，P < 0.001）。
与经验丰富的外科医生相比，外科住院医师为患有中重度疾病的外国患者实施急诊腹腔镜阑尾切除术的比例更高，手术效果相当，中转开腹率更低。
