手术经验对急性胆囊炎的治疗方法真的重要吗？一项随机临床试验。

Does surgical experience really matter on the treatment approach to acute cholecystitis. A randomised clinical trial.

出版信息

Ann Ital Chir. 2021;92:38-34.

Abstract

AIM

Experienced surgeons usually prefer early laparoscopic cholecystectomy (ELC) instead of delayed laparoscopic cholecystectomy (DLC) for the treatment of acute cholecystitis (AC). However, the question remains, if ELC is also safe for beginner surgeons. This study compares ELC versus DLC for the treatment of AC as a beginner surgeon approach.

MATERIAL AND METHODS

In this prospective randomized clinical trial, patients suffering AC in their first 72 hours of pain were enrolled either in Group L (n:88); patients were treated surgically with ELC immediately or Group D (n:88); patients were first treated medically and than treated surgically with DLC 4-8 weeks later. All operations and medical treatments were done by the same beginner surgeon.

RESULTS

In Group L operation time was 60 (50-65) minutes, total hospital stay was 1.5 (1-7) days and total cost was 337.38±78.46 (287-827) USD. In Group D operation time was 50.5 (45-60) minutes, total hospital stay was 5.5(3-15) days and total cost was 499.29±199.38 (321-1506) USD. There were no significant differences regarding to the complications (p>0.05). Hospital stay and total costs were significantly higher in Group D (p<0.001).

CONCLUSIONS

This study indicates, that ELC can definitely be chosen as a treatment approach for AC even by beginner surgeons, considering that it reduces hospital stay and total cost.

KEY WORDS

Acute Cholecystitis, Delayed laparoscopic cholecystectomy, Early laparoscopic cholecystectomy, Surgical work experience.

摘要

目的

有经验的外科医生通常更倾向于早期腹腔镜胆囊切除术（ELC）而非延迟腹腔镜胆囊切除术（DLC）来治疗急性胆囊炎（AC）。然而，对于初学者外科医生来说，ELC 是否同样安全仍然存在疑问。本研究比较了初学者外科医生采用 ELC 与 DLC 治疗 AC 的效果。

材料和方法

这是一项前瞻性随机临床试验，将首次发病 72 小时内疼痛的 AC 患者纳入研究，分为 L 组（n=88）；患者立即接受 ELC 手术治疗或 D 组（n=88）；患者首先接受药物治疗，然后在 4-8 周后接受 DLC 手术治疗。所有手术和药物治疗均由同一位初学者外科医生完成。

结果

L 组的手术时间为 60（50-65）分钟，总住院时间为 1.5（1-7）天，总费用为 337.38±78.46（287-827）美元。D 组的手术时间为 50.5（45-60）分钟，总住院时间为 5.5（3-15）天，总费用为 499.29±199.38（321-1506）美元。两组的并发症发生率无显著差异（p>0.05）。D 组的住院时间和总费用显著高于 L 组（p<0.001）。