中国外科医生对近端胃切除及消化道重建的认知和治疗选择现况调查  

Proximal gastrectomy and digestive tract reconstruction:status survey of perceptions and treatment selection in Chinese surgeons

作　　者：李治国 董剑宏[1] 黄庆兴[1] 陶凯[1] 马俊[1] 张万红[1] Li Zhiguo;Dong Jianhong;Huang Qingxing;Tao Kai;Ma Jun;Zhang Wanhong(Department of Minimal Invasive Digestive Surgery,Shanxi Tumor Hospital,Shanxi Medical University,Taiyuan,Shanxi 030013,China)

机构地区：[1]山西省肿瘤医院消化微创外科中心,太原030013

出　　处：《中华胃肠外科杂志》2020年第8期757-765,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：山西省重点研发计划项目(201803D31167)。

摘　　要：目的由于近端胃癌具有一定特殊性和复杂性,目前对其手术切除范围和消化道重建,学术界争议颇多。本研究旨在了解中国外科医生对近端胃切除及消化道重建的认知和态度以及治疗选择的现况。方法采用横断面调查研究的方法。研究对象:(1)全国范围内具有胃癌诊疗资质的公立三级甲等(省级和地市级)肿瘤专科医院和综合医院;(2)具有高年资主治医师、副主任医师及主任医师职称的外科医生。使用"问卷星"平台设计关于"近端胃切除及消化道重建"认知和治疗选择的调查问卷,问卷内容包含:医生基本信息,开展胃癌手术现况,对于近端胃癌手术方式及相关细节的选择和处理,近端胃切除及消化道重建方式的选择,近端胃切除术后相关并发症及营养状况监测等32个问题,并通过微信向调查对象发送问卷链接。2019年7月29日至8月25日,共发出问卷76份。采用χ2检验或秩和检验进行组间比较。结果共纳入47家三甲医院,共发放调查问卷76份,回收问卷及有效问卷所占比率均为100%。对于早中期、尤其<4 cm的食管胃结合部腺癌(AEG),72.37%(55/76)的医生优先考虑行近端胃切除术,而22.37%(17/76)的医生选择行全胃切除术;90.79%(69/76)的医生认为早期AEG可以考虑内镜黏膜下剥离术(ESD)或者近端胃切除术,60.53%(46/76)的医生认为T3以下、肿瘤在4 cm以下的AEG优先考虑近端胃切除术,60.53%(46/76)的医生认为根治度较高的进展期AEG行近端胃切除术,残胃不小于1/2;若考虑抗反流效果、术后体质量恢复及临床效果好,适用范围广又容易推广,中国外科医生优先选择双通道重建;肿瘤专科医院的外科医生对施行近端胃切除术及认为Kamikawa吻合最不易被推广使用的认同率要高于省级及地市级综合三甲医院外科医生;年手术量在200例以上的外科医生对于早中期AEG选择近端胃切除术的比例高达8/9;认为"临床效果好Objective To understand the perceptions,attitudes and treatment selection of Chinese surgeons for proximal gastrectomy(PG)and digestive tract reconstruction.Methods A cross-sectional survey was used in this study.Selection of subjects:(1)Domestic public grade IIIA(provincial and prefecture-level)tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2)Surgeons with senior attending physician,associate chief physician and chief physician.The"Questionnaire Star"platform was used to design a questionnaire about cognition,attitude and treatment choice of"proximal gastrectomy and digestive tract reconstruction".The questionnaire contained 32 questions,such as the basic information of surgeons,the current status of gastric cancer surgery,the selection and management of surgical methods and related details for proximal gastric cancer,the choice of proximal gastrectomy and reconstruction of digestive tract,the related complications and nutritional status monitoring after proximal gastrectomy.A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25,2019.Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables.Results A total of 47 grade IIIA hospitals were included,and 76 questionnaires were sent out.The proportions of recovered and valid questionnaires were both 100%.For early and middle stage adenocarcinoma of esophagogastric junction(AEG),especially those smaller than 4 cm,72.37%(55/76)of surgeons preferred proximal gastrectomy,while 22.37%(17/76)of surgeons chose total gastrectomy.For early AEG,90.79%(69/76)of surgeons thought that endoscopic submucosal dissection(ESD)or proximal gastrectomy could be considered.For AEG below T3 stage and shorter than 4 cm,60.53%(46/76)of surgeons gave priority to proximal gastrectomy,and 60.53%(46/76)of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy,and the residual stoma

关 键 词：近端胃切除术 消化道重建 认知 治疗选择 问卷调查 

分 类 号：R735.2[医药卫生—肿瘤]