Martin Matt B, Earle Kristen R
Central Carolina Surgery, P.A., 1002 North Church Street, Suite 302, Greensboro, NC 27401, USA.
Am Surg. 2010 Mar;76(3):287-91.
This retrospective review supports the hypothesis that a surgeon acting as first assistant during laparoscopic cholecystectomy will reduce the incidence of significant common bile duct (CBD) injuries (BDIs). Central Carolina Surgery, P.A., is a single-specialty general surgery group of 19 surgeons that have performed 8767 laparoscopic cholecystectomies from October 1999 to December 2007. In those cases, 89 per cent of the cases had surgeons as first assistants and 66 per cent of the cases were performed with intraoperative cholangiography. Five cases of BDI occurred during this period for an incidence of 0.0570 per cent. Only three of these injuries required bilioenteric anastomotic reconstruction. When this same group of surgeons learned to perform laparoscopic cholecystectomy in 1990, their published series (Surgical Endoscopy: [1993] 7: 300 to 303] of 762 cases had 98 per cent of cases performed with a surgeon as first assistant and no CBD injuries. Only 27 per cent of those 762 cases had intraoperative cholangiograms. This single-practice general surgery experience supports the use of a surgeon as first assistant to lower the incidence of CBD injures.
在腹腔镜胆囊切除术中担任第一助手的外科医生将降低严重胆总管（CBD）损伤（BDI）的发生率。卡罗来纳中部外科医师协会（Central Carolina Surgery, P.A.）是一个由19名外科医生组成的单一专科普通外科团队，从1999年10月至2007年12月共进行了8767例腹腔镜胆囊切除术。在这些病例中，89%的病例有外科医生担任第一助手，66%的病例进行了术中胆管造影。在此期间发生了5例BDI，发生率为0.0570%。其中只有3例损伤需要进行胆肠吻合重建。当同一组外科医生在1990年学会进行腹腔镜胆囊切除术时，他们发表的762例病例系列（《外科内镜杂志》：[1993]7: 300至303）中有98%的病例有外科医生担任第一助手，且无CBD损伤。在这762例病例中，只有27%进行了术中胆管造影。这一单一普通外科实践经验支持使用外科医生作为第一助手以降低CBD损伤的发生率。
