Laparoscopic cholecystectomy in the new millennium - How far have we come?
Laparoscopic cholecystectomy in the new millennium - How far have we come?
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DOI：
10.1007/s004640080004
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发表时间：
2001-08-01
影响因子：
3.1
通讯作者：
Friedman, RL
中科院分区：
文献类型：
--
作者：
Lichten, JB;Reid, JJ;Friedman, RL
背景：腹腔镜胆囊切除术已成为治疗症状性胆石症的金标准。许多作者，包括我们机构的研究人员，他们在1992年7月报道了腹腔镜胆囊切除术的初步经验之一，已经记录了与此程序相关的明确的学习曲线。我们提出了一个后续的研究，我们的经验与腹腔镜胆囊切除术，并比较这些数据的早期研究的初步经验与腹腔镜胆囊切除术在贝斯以色列医疗center.Methods：我们回顾性分析了300例连续患者从1998年3月至1999年3月。患者人群在年龄、性别和美国麻醉学会（阿萨）分类方面与原始研究的流行病学相似。然而，尽管最初的人群仅包括慢性疾病患者，但在我们的研究中，13.7%的患者因急性胆道结石病通过急诊室入院。我们发现5.7%的转换率，1%的严重并发症发生率，5.7%的轻微并发症发生率，而最初的研究的发生率为12%，4%，分别为10%。在原始研究中，没有患者在手术当天离开医院，只有49%的患者在1天内出院，而在我们组中，29名患者（10%）接受了门诊手术，另外186名患者（62%）在术后第1天出院。手术的平均持续时间为90分钟，这并不代表一个统计学上的改善，在早期的研究中报告的时间为93分钟。结论：自1992年以来，转换率和住院时间在我们医院下降，但手术时间基本上保持不变。这些发现可能反映了双峰学习曲线，胆管造影和额外的术中操作的数量增加，目前用腹腔镜胆囊切除术治疗的胆囊疾病的严重程度更高，以及主治医生数量的增加以及执行此程序的居民的水平。
Background: Laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic cholelithiasis. Many authors-including investigators at our institution, who reported one of the initial experiences with laparoscopic cholecystectomy in July 1992-have documented a definite learning curve associated with this procedure. We present a follow-up study of our experience with laparoscopic cholecystectomy and compare these data to an earlier study of the initial experience with laparoscopic cholecystectomy at the Beth Israel Medical Center.Methods: We retrospectively reviewed 300 consecutive patients from March 1998 through March 1999. The patient population was epidemiologically similar to that of the original study with regard to age, sex, and American Society of Anesthesia (ASA) classification. However, whereas the initial population included only patients with chronic disease, in our study 13.7% of the patients had been admitted through the emergency room with acute stone disease of the biliary tract.Results: We found a 5.7% conversion rate, a 1% rate of major complication, and a 5.7% rate of minor complication rates, as compared to the initial study's rates of 12%, 4%, and 10%, respectively. Whereas none of the patients in the original study left the hospital on the day of surgery and only 49% were discharged within 1 day, in our group, 29 patients (10%) underwent ambulatory procedures and an additional 186 patients (62%) were discharged on the 1st post-operative day. The average duration of the operation was 90 min, which did not represent a statistical improvement over the time of 93 min reported in the earlier study.Conclusions: Since 1992, both the conversion rate and length of stay have declined at our hospital, but operative time has remained essentially the same. These findings probably reflect a bimodal learning curve, the increase in the number of cholangiograms and additional intraoperative procedures now performed, the greater severity of gallbladder disease currently treated with laparoscopic cholecystectomy, and increases in the number of attending physicians as well as the level of residents who perform this procedure.