AITS 腹腔镜培训中心对外科医生阑尾切除术偏好的影响。
Impact of AITS laparoscopic training center on surgeons' preference for appendectomy.
机构信息
Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan, ROC.
出版信息
Surg Endosc. 2010 Sep;24(9):2210-5. doi: 10.1007/s00464-010-0930-4. Epub 2010 Feb 23.
BACKGROUND
Acute appendicitis is the most common acute abdomen in general surgery. Show-Chwan Memorial Hospital began an AITS/IRCAD laparoscopic training program in late May 2008. In this retrospective analysis, we surveyed the impact of the AITS training program on surgeons' preference for open appendectomy (OA) versus laparoscopic appendectomy (LA).
METHODS
From January 1, 2004 to July 31, 2009, patients diagnosed with acute appendicitis in Changhua Show-Chwan Memorial Hospital and Chang-Bing Show-Chwan Memorial Hospital were retrospectively analyzed. Demographic data, laboratory examinations, surgical methods, hospital stay, and complication rate data were collected and analyzed. The LA rate and effect of surgeons' preference before and after AITS were compared.
RESULTS
In all, 1,267 patients (58.2% male and 41.8% female; mean age, 36.6 years) were diagnosed with acute appendicitis during this period. Among them, 78.9% of patients had uncomplicated and 21.1% complicated appendicitis; 784 patients (61.9%) underwent OA, and 465 (36.7%) received LA. In 2004, only 8.1% of patients underwent LA, but the number increased rapidly to 90.4% in 2009 (P < 0.001). The average LA rate before AITS was 21%; however, after AITS, the LA rate increased to 84.6% (P < 0.001). The LA rate increased for all surgeons completing the training course, ranging from 16 to 83%. The overall appendectomy complication rate was 8.4%, with no significant difference between OA (9.7%) and LA (6.5%; P = 0.174). Hospital stay was shorter in the LA group (4.05 ± 1.9 days) compared with the OA group (4.55 ± 3.6; P = 0.006).
CONCLUSIONS
Attending the laparoscopic training course significantly increased surgeons' preference for LA.
背景
急性阑尾炎是普通外科最常见的急腹症。始兴纪念医院于 2008 年 5 月下旬开始了 AITS/IRCAD 腹腔镜培训计划。在这项回顾性分析中，我们调查了 AITS 培训计划对外科医生选择开腹阑尾切除术 (OA)与腹腔镜阑尾切除术 (LA)的影响。
方法
从 2004 年 1 月 1 日至 2009 年 7 月 31 日，对彰化秀传纪念医院和彰滨秀传纪念医院诊断为急性阑尾炎的患者进行回顾性分析。收集并分析了人口统计学数据、实验室检查、手术方法、住院时间和并发症发生率数据。比较了 AITS 前后 LA 率和外科医生偏好的变化。
结果
共有 1267 例患者（58.2%为男性，41.8%为女性；平均年龄为 36.6 岁）在此期间被诊断为急性阑尾炎。其中，78.9%的患者为单纯性阑尾炎，21.1%为复杂性阑尾炎；784 例（61.9%）患者行 OA，465 例（36.7%）患者行 LA。2004 年，仅 8.1%的患者行 LA，但该比例迅速上升至 2009 年的 90.4%（P<0.001）。AITS 前 LA 的平均比例为 21%；然而，AITS 后 LA 的比例增加到 84.6%（P<0.001）。所有完成培训课程的外科医生的 LA 率均有所增加，范围为 16%至 83%。总的阑尾切除术并发症发生率为 8.4%，OA（9.7%）和 LA（6.5%）之间无显著差异（P=0.174）。LA 组的住院时间（4.05±1.9 天）短于 OA 组（4.55±3.6 天；P=0.006）。
结论
参加腹腔镜培训课程显著增加了外科医生对 LA 的偏好。
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