Ferzli G S, Fiorillo M A, Hayek N E, Sabido F
Staten Island University Hospital, New York, USA.
J Laparoendosc Adv Surg Tech A. 1997 Jun;7(3):147-50. doi: 10.1089/lap.1997.7.147.
Resident competence in both open and laparoscopic cholecystectomy (LC) has been a concern among general surgeons. Laparoscopic surgery was late in coming at many surgical residency programs in the United States, and many residents have graduated with limited experience in LC. We are chief residents who were fortunate enough to start our training when LC was first introduced at our institution in 1990. This report summarizes our experience with LC in our chief year, during which we performed LC on 147 patients. The average operating time was 37 minutes (range, 12-82 minutes). Six patients (4%) required conversion to an open procedure. There were three complications (2 postoperative cystic duct leaks and 1 intraoperative common bile duct injury) for an overall complication rate of 2%. There was no mortality. It is our conclusion that graduating chief residents with 5 years' exposure to LC may perform the procedure with a complication rate comparable to that reported in the current literature. Insuring that graduating chief residents have adequate training in open cholecystectomy may become a more pressing issue in the near future.
住院医师在开放和腹腔镜胆囊切除术（LC）方面的能力一直是普通外科医生关注的问题。在美国，许多外科住院医师培训项目中，腹腔镜手术开展得较晚，许多住院医师毕业时在LC方面的经验有限。我们是总住院医师，很幸运在1990年LC首次引入我们机构时就开始接受培训。本报告总结了我们在总住院医师年度进行LC的经验，在此期间我们为147例患者实施了LC。平均手术时间为37分钟（范围为12 - 82分钟）。6例患者（4%）需要转为开放手术。有3例并发症（2例术后胆囊管漏和1例术中胆总管损伤），总体并发症发生率为2%。无死亡病例。我们的结论是，接受过5年LC培训的总住院医师毕业时实施该手术的并发症发生率可能与当前文献报道的相当。确保毕业的总住院医师在开放胆囊切除术方面接受充分培训在不久的将来可能会成为一个更紧迫的问题。
