Bile duct injury during laparoscopic cholecystectomy -: Myth or reality of the learning curve?
Bile duct injury during laparoscopic cholecystectomy -: Myth or reality of the learning curve?
复制标题
DOI：
10.1007/s004640000103
复制
发表时间：
2000-07-01
影响因子：
3.1
通讯作者：
Lled贸, S
中科院分区：
文献类型：
--
作者：
Calvete, J;Sabater, L;Lled贸, S
背景：胆管损伤（BDI）是腹腔镜胆囊切除术（LC）的严重并发症，可能与学习曲线的效果有关。这项前瞻性、制度性和纵向研究的目的是比较LC期间BDI发生率与外科医生进展经验的关系。方法：在6年的时间里对784例LC进行检查。他们被分为以下三个连续组：A组（1993-94），B组（1995-96）和C组（1997-98）。评估BDI的发生率和类型、外科医生的经验、术中或术后诊断、修复损伤的治疗以及早期和晚期的发病率和死亡率。结果：BDI的总发病率为1.4%。胆总管横断3例，部分胆管病变4例，胆囊漏4例。BDI的数量在三个不同的时间段保持不变；各组损伤比例差异无统计学意义。大多数BDI是由经验丰富的外科医生造成的。总的来说，36%的BDI在术中被识别出来。采用肝空肠吻合术、t型管直接缝合、囊性残端闭合修复BDI。结论：外科医生的经验与不同时期BDI的数量之间没有关系。因此，LC期间的BDI不能仅仅归因于学习曲线。
Background: Bile duct injury (BDI) is a severe complication of laparoscopic cholecystectomy (LC) that is probably related to the effects of the learning curve. The aim of this prospective, institutional, and longitudinal study is to compare the incidence of BDI during LC in relation to the progressive experience of surgeons.Methods: A total of 784 LC were examined during a 6-year period. They were divided into the following three consecutive groups: group A (1993-94), group B (1995-96), and group C (1997-98). Incidence and type of BDI, experience of the surgeon, intra- or postoperative diagnosis, treatment performed to repair the injury, and early and late morbidity and mortality were evaluated.Results: The overall incidence of BDI was 1.4%. There were three cases of transection of the common bile duct, four partial lesions of the bile duct, and four cystic leakages. The number of BDI was maintained over the three different time periods; there were no statistical differences in the proportion of injuries among groups. Most BDI were incurred by experienced surgeons. In all, 36% of BDI were recognized intraoperatively. Hepaticojejunostomy, direct suture over a T-tube, and closure of the cystic stump were done to repair BDI. There was no additional morbidity or mortality in the patients with BDI,Conclusions: No relation was found between the experience of the surgeon and the number of BDI over the different periods of time. Therefore, BDI during LC cannot be attributed solely to the learning curve.