腹腔镜阑尾切除术——高级实习医生在无监督情况下手术与经验丰富的儿科外科医生手术的结果对比
Laparoscopic appendectomy - Outcomes of senior trainees operating without supervision versus experienced pediatric surgeons.
作者信息
Baumgarten Heron D, Brown Erin G, Russell Kathryn W, Adzick N Scott, Laje Pablo
机构信息
Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
出版信息
J Pediatr Surg. 2019 Feb;54(2):276-279. doi: 10.1016/j.jpedsurg.2018.10.092. Epub 2018 Nov 7.
AIM OF THE STUDY
Pediatric surgery trainees at our program are allowed to perform unsupervised laparoscopic appendectomies during their last year of training to promote independent operative decision-making skills. We reviewed the outcomes of laparoscopic appendectomies done by senior trainees without supervision and compared them to experienced pediatric surgeons.
METHODS
We reviewed 500 laparoscopic appendectomies performed without supervision by the last 10 pediatric surgery trainees during their last year of training (first 50 cases of each trainee). We compared the outcomes of those 500 cases to the outcomes of 200 laparoscopic appendectomies performed by eight experienced pediatric surgeons (last 25 cases of each surgeon). Data are expressed as mean (SD), unless otherwise indicated. A P value of ≤0.05 was regarded as significant.
MAIN RESULTS
Median age in the "trainees" and "surgeons" groups was 11 (range 2-22) and 12 (2-20) years, respectively (P = 0.35). The proportion of perforated appendicitis was similar: 98/500 (19.6%) in the trainees group and 42/200 (21%) in the surgeons group, respectively (P = 0.75). Mean operative time was 41 (SD 14.5) min in the trainees group vs. 39 (SD 16.1) min in the surgeons group (P = 0.05). Minor intraoperative complications occurred in 3/500 (0.6%) cases in the trainees group vs. 1/200 (0.5%) in the surgeons group (P = 0.69). No major complications occurred in either group. Mean hospital stay was 2 (range 0.5-26) and 2.3 (range 0.5-18) days in the trainees and surgeons groups, respectively (P = 0.25). There were 13/500 vs. 5/200 readmissions (P = 0.92), and 1/500 vs. 1/200 reoperations in the trainees and surgeons groups, respectively (P = 0.91).
CONCLUSION
Allowing senior pediatric surgery trainees to perform laparoscopic appendectomies without supervision to stimulate surgical autonomy is safe and does not compromise patient outcomes.
LEVEL OF EVIDENCE
III.
研究目的
在我们的项目中，儿科手术实习生在培训的最后一年可以在无监督的情况下进行腹腔镜阑尾切除术，以提高独立手术决策能力。我们回顾了高级实习生在无监督情况下进行的腹腔镜阑尾切除术的结果，并将其与经验丰富的儿科外科医生的结果进行比较。
方法
我们回顾了过去10名儿科手术实习生在培训最后一年（每位实习生的前50例病例）无监督情况下进行的500例腹腔镜阑尾切除术。我们将这500例病例的结果与8名经验丰富的儿科外科医生进行的200例腹腔镜阑尾切除术（每位外科医生的最后25例病例）的结果进行比较。数据以均值（标准差）表示，除非另有说明。P值≤0.05被视为具有统计学意义。
主要结果
“实习生”组和“外科医生”组的中位年龄分别为11岁（范围2 - 22岁）和12岁（2 - 20岁）（P = 0.35）。穿孔性阑尾炎的比例相似：实习生组为98/500（19.6%），外科医生组为42/200（21%）（P = 0.75）。实习生组的平均手术时间为41（标准差14.5）分钟，而外科医生组为39（标准差16.1）分钟（P = 0.05）。实习生组3/500（0.6%）的病例发生了轻微术中并发症，外科医生组为1/200（0.5%）（P = 0.69）。两组均未发生重大并发症。实习生组和外科医生组的平均住院时间分别为2天（范围0.5 - 26天）和2.3天（范围0.5 - 18天）（P = 0.25）。实习生组和外科医生组的再次入院率分别为13/500和5/200（P = 0.9），再次手术率分别为1/500和1/200（P = 0.91）。
结论
允许高级儿科手术实习生在无监督的情况下进行腹腔镜阑尾切除术以促进手术自主性是安全的，且不会影响患者的治疗效果。
证据级别
III级
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