Harness J K, van Heerden J A, Lennquist S, Rothmund M, Barraclough B H, Goode A W, Rosen I B, Fujimoto Y, Proye C
Department of Surgery, University of California, Davis-East Bay, 1411 E. 31st Street, Oakland, California 94602, USA.
World J Surg. 2000 Aug;24(8):976-82. doi: 10.1007/s002680010168.
What is the future of thyroid surgery in the new millennium? How can surgeons keep abreast of advances in thyroid endocrinology, genetics, surgical therapy, and other aspects of thyroid disease management? How should surgeons be trained to become highly competent in thyroid disease and to perform safe, effective thyroid operative procedures? Nine internationally recognized endocrine surgeons were asked to express their views on these and related subjects. They noted that advances in molecular biology, pathology, and genetics of thyroid disease should allow more tailored surgical approaches during the twenty-first century. Current training of general surgical residents in thyroid and other types of endocrine surgery is highly variable, which may contribute to increased complication rates and number of second operations. The leadership for addressing these deficiencies and promoting a more organized approach to thyroid disease management should come from national endocrine surgery associations and their leaders. It is incumbent upon endocrine surgeons to maintain their central role in the management of many aspects of thyroid disease. Organizing teams of specialists into thyroid centers (centers of excellence) can (1) increase efficiency; (2) increase quality of care; (3) decrease costs; (4) encourage a more individualized approach to surgery; (5) lower complication rates; and (6) foster innovation in technology and disease management. Two years of additional fellowship training in thyroid and endocrine surgery is now being advocated by increasing numbers of national endocrine surgical associations as the best way to prepare surgeons for society's needs for highly skilled, competent thyroid surgeons of the future.
新千年甲状腺手术的未来走向如何？外科医生怎样才能跟上甲状腺内分泌学、遗传学、手术治疗以及甲状腺疾病管理其他方面的进展？外科医生应如何接受培训，才能在甲状腺疾病方面具备高超能力并实施安全、有效的甲状腺手术？九位国际知名的内分泌外科医生受邀就这些及相关主题发表看法。他们指出，甲状腺疾病分子生物学、病理学和遗传学的进展应能在21世纪带来更具针对性的手术方法。目前普通外科住院医师在甲状腺及其他类型内分泌外科手术方面的培训差异很大，这可能导致并发症发生率上升以及二次手术数量增多。解决这些不足并推动采用更有条理的甲状腺疾病管理方法的领导工作应由国家内分泌外科学会及其领导人承担。内分泌外科医生有责任在甲状腺疾病诸多方面的管理中保持核心作用。将专家团队组织成甲状腺中心（卓越中心）可以：（1）提高效率；（2）提升护理质量；（3）降低成本；（4）鼓励采用更个性化的手术方法；（5）降低并发症发生率；（6）促进技术和疾病管理方面的创新。越来越多的国家内分泌外科学会主张，额外进行两年的甲状腺及内分泌外科专科培训，是让外科医生满足社会未来对高技能、有能力的甲状腺外科医生需求的最佳方式。
