Joels Charles S, Langan Eugene M, Cull David L, Kalbaugh Corey A, Taylor Spence M
Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605-5601, USA.
J Am Coll Surg. 2009 May;208(5):692-7, quiz 697.e1; discussion reply 697-9. doi: 10.1016/j.jamcollsurg.2008.12.029.
Vascular surgical education for general surgery residents is concerning as endovascular interventions increase and vascular surgery expands. The purpose of this study was to examine the effects these factors have on vascular surgery case numbers for general surgery residents and statewide surgeons and to report on former general surgery residents' perceptions of vascular surgery in training and practice.
Case numbers for all general surgery residents graduating from the Greenville Hospital System from 1991 to 2007 and for the vascular surgery fellows graduating from 2003 to 2007 were obtained. A database identified case numbers and physician specialty for vascular procedures from 1997 through 2006. A survey gained perspectives of graduated general surgery residents on the vascular experience during residency and practice and on postresidency vascular caseload.
There was significant decline in resident participation in open abdominal aortic aneurysm (22.4 versus 7.7), carotid endarterectomy (37.2 versus 31.1), aortobifemoral bypass (18.6 versus 5.5), and lower extremity bypass (42.8 versus 19.1). Numbers for dialysis access creation (49.0 versus 57.1) were maintained. Statewide, comparing 1997 with 2006, the percentages of procedures performed by vascular surgeons were: abdominal aortic aneurysm (29.3% versus 49%; p < 0.001), carotid endarterectomy (28.9% versus 45.5%; p < 0.001), and dialysis access (4.6% versus 12.3%; p=0.020). The survey of general surgery graduates revealed lower extremity bypass, carotid endarterectomy, abdominal aortic aneurysm, and dialysis access are important in training. Dialysis access was the most common operation performed by the general surgery graduates.
There is a trend toward vascular surgeons and vascular residents performing most open vascular cases. Currently practicing surgeons believe there is value to vascular exposure for general surgeons in training, and vascular surgery should remain in general surgery training.
随着血管腔内介入技术的增加以及血管外科领域的拓展，普通外科住院医师的血管外科教育令人担忧。本研究的目的是探讨这些因素对普通外科住院医师和全州外科医生血管外科手术例数的影响，并报告前普通外科住院医师对血管外科培训及实践的看法。
获取了1991年至2007年从格林维尔医院系统毕业的所有普通外科住院医师以及2003年至2007年毕业的血管外科专科住院医师的手术例数。一个数据库确定了1997年至2006年血管手术的例数及医生专业。一项调查收集了已毕业普通外科住院医师对住院期间及实践中的血管外科经历以及毕业后血管外科病例量的看法。
住院医师参与开放性腹主动脉瘤手术（22.4例对7.7例）、颈动脉内膜切除术（37.2例对31.1例）、主动脉双股动脉旁路移植术（18.6例对5.5例）以及下肢旁路移植术（42.8例对19.1例）的例数显著下降。而建立透析通路的例数（49.0例对57.1例）保持稳定。在全州范围内，将1997年与2006年进行比较，血管外科医生所实施手术的百分比分别为：腹主动脉瘤（29.3%对49%；p<0.001）、颈动脉内膜切除术（28.9%对45.5%；p<0.001）以及透析通路手术（4.6%对12.3%；p=0.020）。对普通外科毕业生的调查显示，下肢旁路移植术、颈动脉内膜切除术、腹主动脉瘤手术以及透析通路手术在培训中很重要。透析通路手术是普通外科毕业生最常实施的手术。
血管外科医生和血管外科住院医师实施大多数开放性血管手术的趋势明显。目前执业的外科医生认为，血管外科培训对普通外科住院医师有价值，血管外科应保留在普通外科培训中。
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