多学科协作模式在肢端肥大症中的应用  

Analysis of multi-disciplinary team mode in the diagnosis and treatment of acromegaly

作　　者：陈政源 沈明[1] 赵曜[1] 寿雪飞[1] 李士其[1] 张朝云[1] 叶红英[1] 李益明[1] 潘力[1] 王镛斐[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中国神经精神疾病杂志》2017年第1期31-35,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:81602191);上海市卫计委(编号:20134280);上海市卫计委(编号:201640058)资助

摘　　要：目的比较多学科协作模式(multi-disciplinary team,MDT)与传统单一外科模式诊治肢端肥大症的疗效差异,探讨MDT模式对于肢端肥大症的诊疗价值。方法回顾性分析245例肢端肥大症患者,根据诊治模式分为传统单一学科模式组(对照组)和MDT组,比较两组的随访率、合并症检出率、手术入路选择、手术全切率、内分泌缓解率、并发症发生率等的差异。结果 MDT组的合并症检出率高于对照组;MDT组的经颅手术比例有较对照组下降的趋势(1.4%vs 6.7%,χ~2=3.39,P=0.066);MDT组的全切率高于对照组(80.3%vs.65.1%,χ~2=6.184,P=0.013);两组的手术后内分泌缓解率无显著差异(70.1%vs.59.3%,χ~2=2.644,P=0.104);综合治疗后MDT组的末次随访内分泌缓解率高于对照组(81.1%vs.67.4%,χ~2=5.185,P=0.023)。结论 MDT模式能够提高肢端肥大症患者的合并症检出率,降低经颅手术比例,提高手术全切率及综合治疗后内分泌缓解率,优于传统的单一学科诊疗模式。Objective To compare the efficacy in the diagnosis and treatment of acromegaly between multi-disci- plinary team （MDT） and traditional single discipline team mode, and to discuss the value of MDT mode in the diagnosis and treatment of aeromegaly. Methods The clinical data of 245 acromegalic patients was collected retrospectively and di- vided into 2 groups： traditional single discipline team mode group （control group） and MDT group. Differences were com- pared between these two groups in different parameters including follow-up rates, prevalence of acromegaly related com- plications, surgical approaches, gross total resection rates, endocrinological remission rates and surgical complication rates. Results The prevalence of acromegaly related complications was significantly higher in MDT group than in control group. The rate of transcranial surgery showed a decreasing tendency in MDT group compared with control group （ 1.4% vs. 6.7%, ,12=3.39, P=0.066）. The gross total resection rate was higher in MDT group than in control group （80.3% vs. 65.1%, X2=6.184, P = 0.013）. The endocrinological remission rate after surgery was similar between two groups （70.1% vs. 59.3%,/7=2.644, P= 0.104）. The endocrinological remission rate of last follow-up was significantly higher in MDT group than in control group （81.1% vs. 67.4%,/7=5.185, P= 0.023 ） after adjuvant therapy. Conclusions M DT mode is superior to the traditional single discipline team mode. Compared with traditional single discipline team mode, MDT mode can increase the detecting rate of aeromegaly related complications, decrease the percentage of transcranial sur- gery, boost the gross total resection rate and the endoerinological remission rate of last follow-up.

关 键 词：肢端肥大症 垂体腺瘤 多学科协作团队 诊断 治疗 

分 类 号：R584.11[医药卫生—内分泌]