简介胰十二指肠切除术(PD)的执行方式在世界各地可能有很大差异,也没有商定的标准方法。要了解更多关于PD在印度的实践,在印度外科医生中进行了一项调查,以收集有关他们当前实践的信息。方法创建了一项调查,并与从事胰腺手术的印度外科医生共享。它有33个问题,旨在获取有关PD实践不同方面的信息。这些问题涵盖了诸如外科医生的教育和经验等主题,他们在手术前如何评估病人,他们在手术中考虑的是什么,以及他们在手术后如何管理病人。结果共有129名外科医生接受调查,110人完成了。结果显示,40.9%的外科医生经验不足五年,其中36.4%的人一年内完成了15次以上的PD。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,而其余的则考虑了其他具体的适应症。大多数外科医生(72.7%)在手术前观察白蛋白水平的趋势以评估患者的营养状况。76.4%的参与者将静脉浸润视为新辅助治疗的原因。而95.5%的人在静脉基台的情况下考虑了前期手术。当涉及到PD的类型时,40%首选经典PD,40.9%首选幽门切除PD(PRPD),其余选择保留幽门的PD(PPPD)。胰肠造口术(PJ)是77.3%外科医生的首选方法,而6.3%的人首选胰胃吻合术(PG)。当导管直径较小时,约65.5%的外科医生在手术中选择性使用奥曲肽。几乎所有外科医生(94.5%)都倾向于在PD期间确保进食通道。他们都放置了腹膜内的排水沟。至于术后护理,37.3%的外科医生在48小时内尝试早期经口进食,而28.2%的人更愿意在开始口服前等待至少48小时。结论调查显示,印度外科医生之间的PD练习方式存在显着差异,强调他们的方法和偏好的异质性。
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.