年轻医师腹腔镜胆囊切除术的学习曲线探讨

目的总结腹腔镜胆囊切除术（LC）学习中的经验，探讨促进年轻医师LC的科学学习方法。方法结合前期学习LC的体会，回顾性分析笔者取得LC手术资格以来（2011年6月）独自施行的198例LC患者的临床资料。结果187例患者成功实施LC，平均手术时间68min；l】例中转开腹完成手术，其中10例因结石或炎症反应致胆囊三角解剖不清；1例胆囊结石慢性胆囊炎急性发作，胆囊i角充血水肿，增厚明显且质硬，解剖过程活动性出血难止。所有病例未发生严重出血、胆管损伤等并发症。术后补液，合并胆囊炎者抗生素治疗，术后12～24h进流食及下床活动，术后平均2．8d出院。随访1～3个月无胆管损伤相关并发症。结论年轻医生学习LC，应在手术分级管理制度管理下，熟悉局部解剖生理及变异，充分利用开腹胆囊切除机会及腔镜模拟操作系统学习，遵循学习曲线循序渐进，适应证、禁忌证及中转开腹时机的合理把握，才能科学、安全及扎实地掌握LC。

Discussion about Learning Curve of Young Surgeons for Laparoseopic Cholecystectomy

Objective To summarize the experiences in learning laparoscopic cholecystectomy （LC） and discuss young surgeons how to learn LC scientifically. Method The clinical data of 198 patients received LC by myself since I got the qualification of LC were analyzed retrospectively. Results LC was performed successfully in 187 patients with an average operation time of 68 min. Eleven patients were converted to laparotomy. In these 11 patients, 10 patients because of unclear anatomy in Catot triangle and 1 patient because of uncontrollable bleeding due to pathologic anatomy in Calot triangle caused by gallstone. All 198 patients did not suffer from complications such as severe hemorrhage or injury of biliary duct. Liquid therapy and antibiotics therapy were applied in patients with cholecystitis after LC. Food intake and ambulation were recovered at 12-24 h after operation. All the patients were discharged from hospital with an average of 2.8 d after LC. There was no complications related bile duct injury in all of the patients. Conclusion Managed by hierarchical operations management system, mastering regional physiological and variant anatomy, making use of other open cholecystectomy and laparoscopic simulative learning system well, complying with the learning curve, controlling the indications, contraindications and timing of conversion to laparotomy, young surgeons are able to master LC scientifically, safely, and solidly.