怎样培训优秀的消化外科医师

培训一名优秀的消化外科医师,要求做好以下5个阶段：（1）医学本科学习。一名优秀的本科毕业医师,要求具有：①良好的医德医风和专业操守;②良好的医学知识和治病能力;③良好的其他能力,包括沟通、决策、协作、领导、健康倡导、教学能力和拥有专业精神。（2）外科基础培训。在国际上,先进国家已发展到系统性的外科基础培训。培训完毕和考试合格后,可进入不同科目的高级外科培训。（3）普通外科的专业培训。香港的普通外科培训和英国的制度相近,培训结束后参加香港统一考试,通过后可获得香港外科医学院和英国爱丁堡皇家外科医学院的专业医师资格。香港外科医学院和英国爱丁堡皇家外科医学院已认同我国大陆14个培训中心为培训基地,经过这些培训基地培训出来的医师,可参加香港外科医学院和英国爱丁堡皇家外科医学院举行的联合考试,合格后可获得这两所学院的外科专业资格。（4）消化外科小专科培训。消化外科是普通外科培训后其中一个小专科。中国香港和很多先进国家均没有建立一个系统性的培训制度。在香港是否发展普通外科的小专科系统性培训尚在商议中。（5）终生继续学习。终生学习非常重要。在国际上,已经有继续医学教育、持续专业发展、持续专业教育、重新验证和重新认证等讨论。总之,培训优秀的消化外科医师,要从打好根基开始。此外,建立一个国家性的系统外科培训,才能培训出好的外科专业人才。     

如何培训大学附属医院优秀医生

我国现处于经济急速增长，国力不断加强年代，人民对医疗水平期望大幅提升。培训足够优秀的医师刻不容缓。     

自身免疫性胰腺炎与胰腺癌的鉴别诊断

自身免疫性胰腺炎(AIP)是全身炎症-纤维化的胰腺表现,亦是免疫球蛋白G4相关的硬化性疾病.AIP具有独特的临床症状、影像学、血清学、病理组织学及胰腺外症状特点.AIP的临床特征与胰腺癌有相似之处,但也有区别.特别要强调的是仅以临床表现不能明确鉴别两者.对于AIP的诊断目前有两个不同的诊断标准:美国Mayo中心的临床HISORt诊断标准,以及日本胰腺学会和韩国医学中心提出的亚洲诊断标准.AIP确诊后,主要治疗手段为类固醇类药物治疗,治疗效果较好;但在患者良好反应后类固醇类药物是否作为维持治疗尚有争议.     

对“联合肝脏离断和门静脉结扎的二步肝切除术”的述评

联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)是一个非常新的外科手术.该手术主要针对因未来剩余肝脏体积较小而不能接受大范围肝切除术的T分期较晚的肝癌患者而设计的.ALPPS第1步手术后,患者剩余肝脏对手术的反应非常强烈,使得肝脏体积急剧增生.因而可在第1步手术后1周左右施行第2步手术以切除所有肝内肿瘤(R0切除).本文追溯ALPPS的发展历史,描述该手术的传统步骤和手术的偏离等情况,分析该手术的短期疗效.尽管ALPPS后零死亡已有报道,但初步的研究结果表明:ALPPS的手术死亡率和并发症发生率仍然较高.ALPPS后尚没有明确的长远治疗肿瘤效果的报道.该手术在肝硬化肝癌患者中能否安全施行尚有疑问.     

外科决定

In managing their patients,surgeons have to make clinical decisions.Looking back,some decisions are correct,while others are incorrect.Does making a wrong clinical decision by a surgeon constitute prof...     

胆囊癌专题系列文章述评

This is a series of four papers on "Gallbladder Cancer" written by the most famous hepatobiliary surgeons and oncologists in China. The titles of the papers are: ( 1 )" Preoperative management of patients with suspected gallbladder cancer"by CHEN Wei and LIANG Li-jian; (2)"Selection of surgical procedures for gallbladder cancer" by PENG Shu-you and HONG De-fei; (3) "Diagnosis and treatment of incidental gallbladder cancer" by JIANG Xiao-qing and QIU Ying-he; (4)"Comprehensive management of gallbladder cancer" by WANG Jian-dong and QUAN Zhi-wei. These papers emphasize on the following important points on gallbladder cancer: (1)Laparoscopic cholecystectomy is absolutely contraindicated when gallbladder cancer is known or suspected pre-operatively; patients with a pre-operative suspicion of gallbladder cancer should undergo laparotomy, exploration and cholecystectomy after proper pre-operative assessment; (2)With the exception of Tis and T1a tumors, all patients with resectable gallbladder cancer should receive radical cholecystectomy, and a R0 resection should be aimed at; ( 3 ) For patients whose cancer is an incidental finding on pathological review, a second radial resection should be carried out as soon as possible, except for Tis and T1a diseases;(4) There is very little role for chemotherapy and radiotherapy in the adjuvant or palliative treatment of gallbladder cancer; (5)Surgery is the only curative treatment for gallbladder cancer.     

血府逐瘀汤加味治疗淤胆型肝炎80例

目的 :探讨活血化瘀凉血退黄类中药配伍治疗淤胆型肝炎的疗效。方法 :采用血府逐瘀汤加味 (桃仁、红花、川芎、柴胡、枳壳、桔梗、葛根、丹参、茵陈蒿等 )治疗淤胆型肝炎 80例。结果 :总有效率 93.75 %。提示 :本方有活血化瘀 ,凉血退黄功效。     

外科决定

外科决策与外科决定是2种不同层次的策略。前者是领导和管理人员决定外科整体发展方向和水平定位,不在本文讨论之中。后者是外科医师在治疗时所作的决定。这些决定有对有错,外科医师只能希望决定对时多,错时少。但是否每一个错误的决定,都是外科医师医疗疏忽所致呢？     

射频消融治疗肝癌—对手、挑战和发展

1射频消融在治愈性治疗肝癌的对手和挑战肝癌治愈性治疗的主要手段,可分为以下3种:1.1局部消融这种治疗手段,主要是在超声或CT引导下,经皮穿刺把针或探头放入肿瘤中的适当位置,通过注射化学药物或释放能量,把癌细胞杀死。局部消融的适应证为局限于肝内的肝癌。以前     

腹腔镜手术治疗胰腺肿瘤的现状

Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use.In the past,minimally invasive techniques in pancreatic surgery were only used for diagnostic laparoscopy,staging of pancreatic cancer and palliative procedures for unresectable pancreatic cancer.A growing number of case series and multi-institutional reports on safety and efficacy of minimally invasive pancreatic resection have been published.Current knowledge on minimally invasive pancreatic resection is based mainly on short-term outcomes from a small number of centers with cohorts too small to make strong arguments for or against its use.In carefully selected patients,minimally invasive pancreatic resection is safe and feasible.However,the procedure should only be attempted by surgeons who are experienced in open pancreatic surgery and in laparoscopic surgery.The role and oncologic safety of minimally invasive approach for pancreatic resection for pancreatic cancer remain unknown.