Bramhall S R, Crundwell M C, Durr C, Goldman M D
Department of Surgery, Birmingham Heartlands Hospital, UK.
J R Coll Surg Edinb. 1996 Jun;41(3):155-9.
There has been recent concern regarding the widespread introduction of laparoscopic procedures without adequate training. We report a 2 year prospective series of 229 consecutive open and laparoscopic cholecystectomies, following the introduction of laparoscopic surgery at a district general hospital. All laparoscopic cholecystectomies were performed by surgeons without formal training in this procedure. The proportion of laparoscopic cholecystectomies rose from 27% in 1992 to 62% in 1993, with a conversion rate of 14%. An overall complication rate of 23% was recorded, 29% for open cholecystectomy and 16% for laparoscopic cholecystectomy. Procedure specific complication rates were 6% and 3% respectively. No major bile duct injuries occurred and the 30-day mortality was 0.9%. We conclude that laparoscopic cholecystectomy has been introduced as a safe procedure in this hospital, as compared to open cholecystectomy. It is recommended that new techniques should be introduced carefully and monitored by means of prospective audit.
近期，人们对在未接受充分培训的情况下广泛开展腹腔镜手术表示担忧。我们报告了一家地区综合医院引入腹腔镜手术后连续进行的229例开放和腹腔镜胆囊切除术的2年前瞻性系列病例。所有腹腔镜胆囊切除术均由未接受过该手术正规培训的外科医生进行。腹腔镜胆囊切除术的比例从1992年的27%升至1993年的62%，中转开腹率为14%。记录的总体并发症发生率为23%，开放胆囊切除术为29%，腹腔镜胆囊切除术为16%。特定手术的并发症发生率分别为6%和3%。未发生重大胆管损伤，30天死亡率为0.9%。我们得出结论，与开放胆囊切除术相比，腹腔镜胆囊切除术在本院已作为一种安全的手术方式被引入。建议新技术应谨慎引入并通过前瞻性审计进行监测。
