Fischer Craig P, Hong Johnny C
Department of Surgery, The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX 77030, USA.
J Gastrointest Surg. 2006 Apr;10(4):478-82. doi: 10.1016/j.gassur.2006.01.010.
Current trends in national health care are triggering a reassessment of training in general surgery. Currently, 75% of general surgery residents seek postgraduate fellowship training, and significant debate has occurred regarding the best manner for surgeons to acquire competency in performing complex operations. Pancreaticoduodenectomy (PD) is a complex procedure performed infrequently by most surgical graduates. From 1990 through 1997, the average number of PD operations performed per general surgery graduate ranged from 1.5 to 2.5. We examine the surgical outcomes following PD performed by surgical resident staff in a university-based general surgery training program. Between January 2001 and October 2004, 164 patients underwent PD for periampullary disease. Data were prospectively entered into a computerized database, including resident participation. We analyzed 30-day mortality and morbidity rates. Perioperative outcomes were 30-day mortality (2.2%), pancreatic fistula (6.1%), reoperation (2.2%), average length of hospital stay (13.5 days), mean operating time (489 minutes), and median estimated blood loss (1274 ml per case). PD can be performed with an acceptable morbidity and mortality within the teaching structure of a general surgery training program. These outcomes are likely related to the performance of PD at a high-volume, tertiary center by a single surgeon and compare favorably to best-practice benchmark outcomes.
当前国家医疗保健的趋势正在引发对外科普通培训的重新评估。目前，75%的普通外科住院医师寻求研究生奖学金培训，并且对于外科医生获得复杂手术操作能力的最佳方式已经出现了重大争论。胰十二指肠切除术（PD）是大多数外科毕业生很少进行的复杂手术。从1990年到1997年，每位普通外科毕业生进行的PD手术平均数量在1.5至2.5例之间。我们研究了在一个大学普通外科培训项目中，外科住院医师团队进行PD手术后的手术结果。在2001年1月至2004年10月期间，164例患者因壶腹周围疾病接受了PD手术。数据被前瞻性地录入计算机数据库，包括住院医师的参与情况。我们分析了30天死亡率和发病率。围手术期结果为30天死亡率（2.2%）、胰瘘（6.1%）、再次手术（2.2%）、平均住院时间（13.5天）、平均手术时间（489分钟）以及中位估计失血量（每例1274毫升）。在普通外科培训项目的教学结构内，PD手术可以在可接受的发病率和死亡率范围内进行。这些结果可能与在一个高容量的三级中心由单一外科医生进行PD手术有关，并且与最佳实践基准结果相比具有优势。
