Schauer P R, Page C P, Stewart R M, Schwesinger W H, Sirinek K R
Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842.
Am J Surg. 1994 Dec;168(6):566-9; discussion 569-70. doi: 10.1016/s0002-9610(05)80123-0.
The purpose of this study was to determine the impact of laparoscopic cholecystectomy (LC) on resident training.
We reviewed our experience over an 11-year period, from academic years 1982 to 1992, with 3,046 patients who underwent elective open cholecystectomy (OC) and 640 patients who underwent LC.
Prior to LC, junior residents performed 80% of all cholecystectomies, with a morbidity and mortality rate of 4% and 0.04%, respectively, compared with 11% and 0.3%, respectively, for senior residents who operated on higher-risk patients. Since the introduction of the technique, there has been a 25% increase in cholecystectomies per year, and a reduction in junior resident OC experience by 67%. Currently, 72% of all cholecystectomies are performed laparoscopically by senior residents.
The replacement of OC by LC has produced a qualitative change in the operative experience of our junior residents and a delay in acquisition of operative skills. The reduction in OC experience by residents may jeopardize their ability to perform the difficult open cases.
本研究的目的是确定腹腔镜胆囊切除术（LC）对住院医师培训的影响。
我们回顾了1982学年至1992学年这11年期间的经验，其中3046例患者接受了择期开腹胆囊切除术（OC），640例患者接受了LC。
在LC开展之前，初级住院医师完成了所有胆囊切除术的80%，其发病率和死亡率分别为4%和0.04%，而对高危患者进行手术的高级住院医师的发病率和死亡率分别为11%和0.3%。自该技术引入以来，每年胆囊切除术增加了25%，初级住院医师的OC经验减少了67%。目前，所有胆囊切除术中的72%由高级住院医师通过腹腔镜完成。
用LC取代OC已使我们初级住院医师的手术经验发生了质的变化，并延迟了手术技能的获得。住院医师OC经验的减少可能会危及他们处理困难开腹病例的能力。
