Jacquat P, Tevaearai H, Cuttat J F, Wassmer F A
Service de chirurgie générale, CHUV, Lausanne.
Schweiz Med Wochenschr. 1993 Apr 3;123(13):569-70.
Laparoscopic cholecystectomy is a relatively recent acquisition and still remains limited to a few surgeons. We started an education program for surgeons used to open biliary surgery. Between September 1990 and December 1991, 208 patients have been operated on day 14 operators flanked by 2 teachers. Technique was standardized and all patients were examined preoperatively for absence of stones in bile ducts using i.v. cholangiography and tomography. Only 6 patients (< 3%) needed to be converted to laparotomy. Morbidity was less than 6% and due to minor complications. Only one patient needed reoperation because of incisional hernia. Mortality was nil. Mean postoperative hospitalization time was less than 3 days. We conclude that laparoscopic activity in a teaching center allows acquisition of a new technique modality while remaining safe for patients.
腹腔镜胆囊切除术是一项相对较新的技术，目前仍仅限于少数外科医生掌握。我们为习惯开放式胆道手术的外科医生开展了一项培训计划。在1990年9月至1991年12月期间，由14名操作人员在2名带教老师的协助下，为208例患者实施了手术。手术技术实现了标准化，所有患者术前均通过静脉胆管造影和断层扫描检查胆管内有无结石。只有6例患者（<3%）需要转为开腹手术。发病率低于6%，且均为轻微并发症。只有1例患者因切口疝需要再次手术。无死亡病例。术后平均住院时间少于3天。我们得出结论，教学中心开展腹腔镜手术能够让医生掌握一种新的技术方式，同时对患者而言仍较为安全。
