Oniscu G C, Paterson-Brown S
Department of Clinical and Surgical Science (Surgery), The Royal Infirmary of Edinburgh Lauriston Place, Edinburgh.
Surgeon. 2003 Feb;1(1):51-7. doi: 10.1016/s1479-666x(03)80011-2.
The last twenty years have seen significant changes in both the incidence and treatment of gastro-oesophageal disorders as well as a process of subspecialisation in general surgery. The aim of this study is to identify the changes in gastro-oesophageal surgery in Scotland during this period.
A retrospective analysis of three years of data, taken over a 20-year period (1977, 1987 and 1997) obtained from the Information and Statistics Division of the Scottish National Health Service, examining the number of patients with oesophageal cancer, gastric cancer and gastro-oesophageal reflux disease (GORD) treated by general and thoracic surgeons.
There was a significant increase (p=0.001, chi2) in the number of patients with oesophageal cancer (2.52-fold) and gastric cancer (1.4-fold) treated by general compared with thoracic surgeons. Since 1977, the overall operability for oesophageal cancer has remained unchanged, while a significant decrease in the overall operability of gastric cancer was noted (p<0.001, chi2). There was a 3-fold increase in the incidence of GORD with a significant increase (p<0.001, chi2) of those treated surgically. Since 1977, there has also been a significant shift of workload from thoracic to general surgical units.
Scotland has seen a consistent increase in the surgical workload generated by gastro-oesophageal malignancies over the last three decades without any improvement in the operability rate. Surgically treated GORD has also increased, probably due to the introduction of minimally invasive techniques. These trends have implications on healthcare planning, resource allocation and surgical training. Appropriate resources and trainees should follow the patients to those units carrying out this activity. Further centralisation of these services is likely to follow.
在过去二十年中，胃食管疾病的发病率和治疗方法都发生了显著变化，普通外科也经历了一个亚专业化的过程。本研究的目的是确定这一时期苏格兰胃食管外科的变化。
对从苏格兰国民医疗服务体系信息与统计部门获取的20年期间（1977年、1987年和1997年）三年的数据进行回顾性分析，研究普通外科医生和胸外科医生治疗的食管癌、胃癌和胃食管反流病（GORD）患者数量。
与胸外科医生相比，普通外科医生治疗的食管癌患者数量显著增加（p = 0.001，卡方检验）（2.52倍），胃癌患者数量增加（1.4倍）。自1977年以来，食管癌的总体可切除率保持不变，而胃癌的总体可切除率显著下降（p < 0.001，卡方检验）。GORD的发病率增加了3倍，手术治疗的患者数量显著增加（p < 0.001，卡方检验）。自1977年以来，工作量也从胸外科显著转移至普通外科。
在过去三十年中，苏格兰胃食管恶性肿瘤产生的外科工作量持续增加，而可切除率却没有任何提高。手术治疗的GORD也有所增加，可能是由于微创技术的引入。这些趋势对医疗规划、资源分配和外科培训具有影响。应将适当的资源和培训人员分配到开展此项工作的科室。这些服务可能会进一步集中。
