Warren W D
Department of Surgery, Emory University School of Medicine, Atlanta, Ga. 30322.
Can J Surg. 1988 Mar;31(2):81-5.
One of the deficiencies in surgical scholarship is the rarity of timely, well-controlled research to evaluate new operative procedures. The invasive aspect of surgery makes randomized studies more difficult to initiate, and in studies with large numbers of participating surgeons, the impact of unsatisfactory surgical expertise (craftsmanship) is a major variable. In an effort to improve surgical research, the use of quality control data for early assessment of the effectiveness of the operative procedure is strongly recommended. Early postoperative studies of stimulated gastric acid secretion have led to improved surgical performance during trials of operations using vagotomy for control of peptic ulcer disease. Similar, early, quality control studies have been effective when investigating selective shunts for control of variceal bleeding; necessary data include shunt patency, portal perfusion of the liver and obliteration of major portoazygous collaterals. Failure to incorporate objective tests for surgical quality control can lead to erroneous assessment of operations. Carefully planned prospective studies of well-performed operations are urgently needed.
外科学术研究的不足之处之一在于，缺乏及时且控制良好的研究来评估新的手术程序。手术的侵入性使得随机研究更难开展，而且在有大量外科医生参与的研究中，手术技术（技艺）欠佳所产生的影响是一个主要变量。为了改进外科研究，强烈建议利用质量控制数据对手术程序的有效性进行早期评估。术后早期对胃酸分泌刺激的研究，在采用迷走神经切断术控制消化性溃疡疾病的手术试验期间，已使手术效果得到改善。同样，早期质量控制研究在调查用于控制静脉曲张出血的选择性分流术时也很有效；所需数据包括分流的通畅情况、肝脏的门静脉灌注以及主要门静脉奇静脉侧支的闭塞情况。未能纳入手术质量控制的客观测试可能会导致对手术的错误评估。迫切需要精心规划的、针对实施良好手术的前瞻性研究。
