Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Surg Endosc. 2010 Sep;24(9):2206-9. doi: 10.1007/s00464-010-0928-y. Epub 2010 Feb 21.
The aim of this study was to evaluate the impact of surgical subspecialization on the outcome of laparoscopic cholecystectomy.
The retrospective cohort study included all consecutive patients who underwent laparoscopic cholecystectomy between June 2002 and June 2009 in a major teaching hospital. Patients were divided into two groups: those operated on by laparoscopy-oriented surgeons (more than 50 laparoscopic procedures annually) and those operated on by nonlaparoscopy surgeons. Surgeries were divided into two groups as well: elective surgery for cholelithiasis and emergency surgery for acute cholecystitis. Conversion rate, operating time, complications, and length of hospital stay were analyzed and compared between both groups.
During the study period 1509 patients underwent laparoscopic cholecystectomy for symptomatic gallstone disease. A laparoscopic surgeon performed the procedure on 893 patients, and 616 patients were operated on by nonlaparoscopy surgeons. For elective surgeries the laparoscopic interest of the surgeon had no influence on the outcome of the procedure. In patients with acute cholecystitis, a significant difference in conversion rate (3.6 vs. 15.6%, p = 0.003) and operating time (68 vs. 76 min, p = 0.02) favored the laparoscopic surgeons.
Patients who present with acute cholecystitis have a greater chance of a laparoscopically completed cholecystectomy if operated on by a laparoscopy-oriented surgeon.
本研究旨在评估手术亚专业对腹腔镜胆囊切除术结果的影响。
这是一项回顾性队列研究，纳入了 2002 年 6 月至 2009 年 6 月期间在一家大型教学医院接受腹腔镜胆囊切除术的所有连续患者。患者分为两组：腹腔镜导向外科医生（每年行腹腔镜手术超过 50 例）和非腹腔镜外科医生。手术也分为两组：胆囊结石的择期手术和急性胆囊炎的急诊手术。分析并比较了两组之间的中转率、手术时间、并发症和住院时间。
在研究期间，1509 例有症状的胆囊疾病患者接受了腹腔镜胆囊切除术。893 例由腹腔镜外科医生进行手术，616 例由非腹腔镜外科医生进行手术。对于择期手术，外科医生的腹腔镜兴趣对手术结果没有影响。对于急性胆囊炎患者，中转率（3.6%比 15.6%，p=0.003）和手术时间（68 分钟比 76 分钟，p=0.02）的差异有统计学意义，有利于腹腔镜外科医生。
对于急性胆囊炎患者，如果由腹腔镜导向的外科医生进行手术，他们更有可能完成腹腔镜胆囊切除术。
