Herbst C A, Elliott L, Koruda M, Maxwell J G
Department of Surgery, University of North Carolina, Chapel Hill 27599-7210.
Surg Laparosc Endosc. 1993 Apr;3(2):95-9.
We compared the first year's experience in performing laparoscopic cholecystectomy in a university hospital and a community hospital to determine the impact of postgraduate surgical training on outcome. Laparoscopic cholecystectomy was attempted on 446 patients. The conversion rate to open cholecystectomy was 8.3% and did not differ between institutions. Surgical house staff performed 43% of the cases at the university hospital compared with 8% at the community hospital. The greater use of laser and cholangiograms resulted in significantly longer mean operative time at the university hospital (141 +/- 26 min) than at the community hospital (114 +/- 52 min). The overall complication rate did not differ significantly (p = 0.15). Complications included common duct injury (three cases), bile leak (five cases), bleeding or hematoma (six cases), epigastric artery hematoma (one case), and death (one case). Operative inexperience during this first year may be a major determinant for the complication rates at both hospitals. It is too early to determine the impact of graduate surgical education on complications. Intense education and supervised instruction is requisite to minimizing the morbidity associated with laparoscopic cholecystectomy regardless of whether it is performed at a university or community hospital.
我们比较了在一所大学医院和一所社区医院开展腹腔镜胆囊切除术的第一年经验，以确定研究生外科培训对手术结果的影响。对446例患者尝试进行了腹腔镜胆囊切除术。转为开腹胆囊切除术的比例为8.3%，两所机构之间无差异。大学医院43%的病例由外科住院医师完成，而社区医院这一比例为8%。大学医院更多地使用激光和胆管造影导致其平均手术时间（141±26分钟）显著长于社区医院（114±52分钟）。总体并发症发生率无显著差异（p = 0.15）。并发症包括胆总管损伤（3例）、胆漏（5例）、出血或血肿（6例）、上腹部动脉血肿（1例）和死亡（1例）。在这第一年中手术经验不足可能是两家医院并发症发生率的主要决定因素。现在确定研究生外科教育对并发症的影响还为时过早。无论在大学医院还是社区医院进行腹腔镜胆囊切除术，强化教育和监督指导对于将与之相关的发病率降至最低都是必不可少的。
