Doerr R J, Yildiz I, Flint L M
Department of Surgery, School of Medicine and Biomedical Sciences, State University of New York, Buffalo.
Arch Surg. 1990 Apr;125(4):463-5. doi: 10.1001/archsurg.1990.01410160049011.
A radical pancreaticoduodenectomy offers the best chance for survival in patients with periampullary and pancreatic malignant neoplasms. A pancreaticoduodenectomy has educational value since complex pancreatic operations are demanding and important to the training of surgical residents. Increased pancreaticoduodenectomy experience (per surgeon) has been associated with improved outcomes. We examined the hypothesis that residents who are supervised by faculty surgeons can perform pancreaticoduodenectomies with acceptable outcomes. From 1976 to 1987, 127 pancreatic resections were performed by 81 residents who were supervised by 15 faculty surgeons in four teaching hospitals. A pancreaticoduodenectomy was performed on 61 patients. All residents served as an operating surgeon on a pancreatic resection, and 58 (82%) performed pancreaticoduodenectomies. The mortality for the pancreaticoduodenectomies was 8%, with a 36% major complication rate. A pancreaticoduodenectomy can be performed safely by residents under supervision. A review of the results identifies the means of improving outcomes. These results justify the preservation of a pancreaticoduodenectomy as an important experience for residents.
根治性胰十二指肠切除术为壶腹周围和胰腺恶性肿瘤患者提供了最佳的生存机会。胰十二指肠切除术具有教学价值，因为复杂的胰腺手术要求高，对于外科住院医师的培训很重要。（每位外科医生）胰十二指肠切除术经验的增加与更好的治疗效果相关。我们检验了这样一个假设，即由带教外科医生监督的住院医师能够进行胰十二指肠切除术并取得可接受的结果。1976年至1987年期间，在四家教学医院中，81名住院医师在15名带教外科医生的监督下进行了127例胰腺切除术。61例患者接受了胰十二指肠切除术。所有住院医师都作为胰腺切除术的主刀医生，其中58例（82%）进行了胰十二指肠切除术。胰十二指肠切除术的死亡率为8%，主要并发症发生率为36%。住院医师在监督下能够安全地进行胰十二指肠切除术。对结果的回顾确定了改善治疗效果的方法。这些结果证明保留胰十二指肠切除术作为住院医师的一项重要经验是合理的。
