Bickel A, Rappaport A, Hazani E, Eitan A
Department of Surgery, Western Galilee Hospital, the Rappaport School of Medicine, the Technion, Israel Institute of Technology, Nahariya.
J Laparoendosc Adv Surg Tech A. 1998 Jun;8(3):137-41. doi: 10.1089/lap.1998.8.137.
Recent observations point to a seemingly high conversion rate to laparotomy in cases of laparoscopic operations for acute cholecystitis that are performed by surgical residents. The purpose of the study is to evaluate those observations. In a retrospective nonrandomized study, conducted between February 1992 and December 1997, 285 laparoscopic operations for acute cholecystitis were analyzed. Those performed by attending surgeons were compared with those performed by residents assisted by attending surgeons. Of 123 laparoscopic operations performed by laparoscopic surgeons between February 1992 and September 1995, 20.3% were converted to laparotomy, compared with 41.3% of the 29 operations performed by the residents (p < 0.017), with no increase in complication rate. Factors like male sex, duration of upper abdominal pain, and severity of the inflammatory process were not significantly different in both groups. The residents' seniority did not influence the conversion rate. A constant and significant decrease in conversion rate to laparotomy was observed over the course of time, as the study proceeded to December 31, 1997 (p < 0.01). We conclude that the performance of difficult laparoscopic cholecystectomy by residents with the assistance of attending surgeons is feasible, but carries a higher conversion rate to laparotomy for reasons that are not entirely clear. The possibility of a learning curve of the residents is suggested.
近期观察结果表明，外科住院医师进行的急性胆囊炎腹腔镜手术中转开腹率似乎较高。本研究旨在评估这些观察结果。在一项1992年2月至1997年12月间进行的回顾性非随机研究中，分析了285例急性胆囊炎腹腔镜手术。将主治医师进行的手术与由主治医师协助住院医师进行的手术进行了比较。在1992年2月至1995年9月间由腹腔镜外科医师进行的123例腹腔镜手术中，20.3%中转开腹，而住院医师进行的29例手术中转开腹率为41.3%（p<0.017），并发症发生率未增加。两组在性别、上腹部疼痛持续时间和炎症过程严重程度等因素方面无显著差异。住院医师的资历并未影响中转开腹率。随着研究进行到1997年12月31日，观察到中转开腹率持续且显著下降（p<0.01）。我们得出结论，在主治医师协助下住院医师进行困难的腹腔镜胆囊切除术是可行的，但中转开腹率较高，原因尚不完全清楚。提示住院医师可能存在学习曲线。
