Kaushal Gourav, Rakesh Nirjhar Raj, Mathew Anvin, Sanyal Sumit, Agrawal Abhishek, Dhar Puneet
Surgical Gastroenterology, All India Institute of Medical Sciences, Bathinda, Bathinda, IND.
Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2023 Jul 13;15(7):e41828. doi: 10.7759/cureus.41828. eCollection 2023 Jul.
Introduction The way pancreatoduodenectomy (PD) is performed can vary a lot around the world, and there is no agreed-upon standard approach. To learn more about how PD is practised in India, a survey was conducted among Indian surgeons to gather information about their current practices. Methods A survey was created and shared with surgeons in India who practice pancreatic surgery. It had 33 questions that aimed to capture information about different aspects of PD practice. These questions covered topics such as the surgeons' education and experience, how they evaluated patients before surgery, what they considered during the operation, and how they managed patients after surgery. Results A total of 129 surgeons were sent the survey, and 110 of them completed it. The results showed that 40.9% of the surgeons had less than five years of experience, and 36.4% of them performed more than 15 PDs in a year. When deciding whether to perform preoperative biliary drainage, 60% of surgeons based their decision on the level of bilirubin in the patient's blood, while the rest considered other specific indications. The majority of surgeons (72.7%) looked at the trend of albumin levels to assess the patient's nutritional status before surgery. Venous infiltration was seen as a reason for neoadjuvant therapy by 76.4% of the participants, whereas 95.5% considered upfront surgery in cases of venous abutment. When it came to the type of PD, 40% preferred classical PD, 40.9% preferred pylorus-resecting PD (PRPD), and the rest chose pylorus-preserving PD (PPPD). Pancreatojejunostomy (PJ) was the preferred method for 77.3% of surgeons, while 6.3% preferred pancreatogastrostomy (PG). About 65.5% of surgeons used octreotide selectively during the operation when the duct diameter was small. Nearly all surgeons (94.5%) preferred to secure feeding access during PD, and all of them placed intraperitoneal drains. As for postoperative care, 37.3% of surgeons attempted early oral feeding within 48 hours, while 28.2% preferred to wait at least 48 hours before initiating oral feeds. Conclusions The survey revealed significant differences in how PD is practised among surgeons in India, highlighting the heterogeneity in their approaches and preferences.
引言
胰十二指肠切除术（PD）的实施方式在世界各地差异很大，且没有公认的标准方法。为了更多地了解印度如何开展PD手术，对印度外科医生进行了一项调查，以收集他们当前手术操作的相关信息。
方法
设计了一项调查并与印度从事胰腺手术的外科医生分享。该调查有33个问题，旨在获取有关PD手术不同方面的信息。这些问题涵盖了外科医生的教育背景和经验、术前如何评估患者、手术中考虑哪些因素以及术后如何管理患者等主题。
结果
共向129名外科医生发送了调查问卷，其中110人完成了调查。结果显示，40.9%的外科医生经验不足五年，36.4%的外科医生每年进行超过15例PD手术。在决定是否进行术前胆道引流时，60%的外科医生根据患者血液中的胆红素水平做出决定，其余医生则考虑其他特定指征。大多数外科医生（72.7%）在术前通过观察白蛋白水平趋势来评估患者的营养状况。76.4%的参与者认为静脉浸润是新辅助治疗的一个原因，而95.5%的人在静脉受侵的情况下考虑直接进行手术。关于PD的类型，40%的人更喜欢经典PD，40.9%的人更喜欢保留幽门的胰十二指肠切除术（PRPD），其余的人选择保留幽门的胰十二指肠切除术（PPPD）。77.3%的外科医生首选胰空肠吻合术（PJ），而6.3%的人更喜欢胰胃吻合术（PG）。当胰管直径较小时，约65.5%的外科医生在手术期间选择性使用奥曲肽。几乎所有外科医生（94.5%）在PD手术期间更喜欢确保建立喂养通道，并且他们都放置了腹腔引流管。至于术后护理，37.3%的外科医生尝试在48小时内尽早进行口服喂养，而28.2%的人更喜欢在开始口服喂养前至少等待48小时。
结论
该调查揭示了印度外科医生在PD手术实施方式上存在显著差异，凸显了他们手术方法和偏好的异质性。
