Meguid A, Scheeres D E, Mellinger J D
Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA.
Am Surg. 1998 Jul;64(7):622-5; discussion 625-6.
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most complex procedures performed by endoscopists. ERCP has been performed primarily by gastroenterologists. There have been no reports in the literature regarding ERCP training within the framework of a general surgery residency program. The purpose of this study was to review ERCPs performed by surgical attendings and resident staff during a 6-year period and compare the success and complication rates with those found in published gastroenterological series. There were a total of 193 ERCPs performed on 171 patients for a success rate of 82.4 per cent and a complication rate of 6.7 per cent. A resident was the primary endoscopist in 51 procedures, with 42 (82.4%) successes and 2 complications (3.9%). There were no significant differences noted between our series and national complication rates, and between attending and resident procedures (P < 0.05, Chi-square analysis). This study has shown that surgical endoscopists can perform ERCP with success rates over 80 per cent, the currently regarded standard of expertise. The complication rates for these ERCPs were lower than accepted complication rates cited in current gastroenterological series. The results of this study support the hypothesis that ERCPs can be performed safely in a surgical residency.
内镜逆行胰胆管造影术（ERCP）是内镜医师所实施的最复杂的操作之一。ERCP主要由胃肠病学家进行。在普通外科住院医师培训项目框架内，关于ERCP培训的文献尚无报道。本研究的目的是回顾外科主治医生和住院医师在6年期间所进行的ERCP，并将成功率和并发症发生率与已发表的胃肠病学系列研究中的数据进行比较。共对171例患者进行了193次ERCP，成功率为82.4%，并发症发生率为6.7%。在51例操作中，住院医师是主要内镜操作者，成功42例（82.4%），并发症2例（3.9%）。我们的研究系列与全国并发症发生率之间，以及主治医生和住院医师的操作之间，均未发现显著差异（P<0.05，卡方分析）。本研究表明，外科内镜医师实施ERCP的成功率超过80%，这是目前公认的专业水平标准。这些ERCP的并发症发生率低于当前胃肠病学系列研究中所引用的公认并发症发生率。本研究结果支持以下假设：在外科住院医师培训中可以安全地进行ERCP。
