Namias N, McKenney M G, Sleeman D, Hutson D G
University of Miami School of Medicine-Jackson Memorial Medical Center, Miami, Florida, USA.
Surg Laparosc Endosc. 1997 Jun;7(3):245-7.
Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) as the most common operation for gallbladder disease. Our goal was to determine the effect of this phenomenon on resident training in biliary surgery. The numbers of all cholecystectomies (ACs), OCs, LCs, and advanced procedures (common bile duct exploration and choledochoscopy, (CBDE) performed by residents during academic years 1989 to 1994 were examined. Trends for the residency as a whole and for each cohort of residents completing the program were studied. The number of LCs performed by the residency as a whole per academic year over the 1989 to 1994 period has increased, whereas the number of OCs decreased. The net effect of these trends was an increase in the number of ACs. Although the percentage of LCs performed by postgraduate year 1, 2, and 3 residents (juniors) increased over the study period, the proportion of OCs and ACs performed by this group decreased. For each cohort of residents completing training in the years 1989 through 1994, the number of ACs and LCs performed increased, whereas the number of OCs decreased. Experience in CBDE for the residency as a whole and for the cohort was stable. In conclusion, experience in ACs and LCs has increased, and experience in OCs has decreased. Also, experience in biliary surgery has shifted to the senior level.
腹腔镜胆囊切除术（LC）已取代开腹胆囊切除术（OC），成为治疗胆囊疾病最常用的手术方式。我们的目标是确定这一现象对胆道外科住院医师培训的影响。我们检查了1989年至1994学年住院医师所进行的所有胆囊切除术（AC）、开腹胆囊切除术（OC）、腹腔镜胆囊切除术（LC）以及高级手术（胆总管探查和胆道镜检查，CBDE）的数量。研究了整个住院医师培训项目以及完成该项目的每一批住院医师的趋势。在1989年至1994年期间，整个住院医师培训项目每年所进行的腹腔镜胆囊切除术数量有所增加，而开腹胆囊切除术的数量则减少。这些趋势的净效应是所有胆囊切除术的数量增加。尽管在研究期间，第一年、第二年和第三年住院医师（低年级住院医师）所进行的腹腔镜胆囊切除术的比例有所增加，但该组所进行的开腹胆囊切除术和所有胆囊切除术的比例却有所下降。对于1989年至1994年期间完成培训的每一批住院医师来说，所进行的所有胆囊切除术和腹腔镜胆囊切除术的数量都有所增加，而开腹胆囊切除术的数量则减少。整个住院医师培训项目以及该批住院医师在胆总管探查和胆道镜检查方面的经验保持稳定。总之，所有胆囊切除术和腹腔镜胆囊切除术的经验有所增加，而开腹胆囊切除术的经验则有所减少。此外，胆道外科的经验已转向高年级住院医师。
