中国经自然腔道取标本手术开展现状分析  

An investigation report on the current situation of natural orifice specimen extraction surgery in China

作　　者：关旭 焦帅 黄海洋 周海涛 傅传刚[3] 韦烨 熊治国[5] 孙东辉[6] 陈路川[7] 蔡建春[8] 何庆泗[9] 马丹 郑阳春[11] 丁克峰[12] 胡军红 彭健[14] 姚宏亮[15] 王贵玉 汪泳[17] 孙学军[18] 李太原[19] 江波[20] 康亮[21] 王锡山 Guan Xu;Jiao Shuai;Huang Haiyang;Zhou Haitao;Fu Chuangang;Wei Ye;Xiong Zhiguo;Sun Donghui;Chen Luchuan;Cai Jianchun;He Qingsi;Ma Dan;Zheng Yangchun;Ding Kefeng;Hu Junhong;Peng Jian;Yao Hongliang;Wang Guiyu;Wang Yong;Sun Xuejun;Li Taiyuan;Jiang Bo;Kang Liang;Wang Xishan(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Bejing 100021,China;Department of Colorectal Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150006,China;Endoscopy Center of Dongfang Hospital Affiliated to Tongji University,Shanghai 200120,China;Department of General Surgery,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Gastrointestinal Surgery,Hubei Cancer Hospital,Wuhan 430070,China;Department of Gastrocolorectal and Anal Surgery,the First Hospital of Jilin University,Changchun 130000,China;Department of Gastrointestinal Surgery,Fujian Cancer Hospital,Fuzhou 350011,China;Department of Gastrointestinal Surgery,Zhongshan Hospital affiliated to Xiamen University,Xiamen,361000 China;Department of Gastrointestinal Surgery,Qilu Hospital,Shandong University,Jinan 250000,China;Department of General Surgery,Xinqiao Hospital,Army Military Medical University,Chongqing 400000,China;Department of Colorectal Cancer,Sichuan Cancer Hospital,Chengdu 610000,China;Department of Oncology,the Second Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310000,China;Department of Colorectal and Anal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Hepatobiliary Surgery,Xiangya Hospital,Central South University,Changsha 410000,China;Department of Gastrointestinal Surgery,Xiangya Second Hospital,Central South University,Changsha 410000,China;Department of Colorectal Surgery,Zhejiang Cancer Hospital,Hangzhou 310000,China;Department of General Surgery,the Second Affiliated Hospital of Anhui Medical Univer

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [2]哈尔滨医科大学附属第二医院结直肠肿瘤外科,哈尔滨150006 [3]同济大学附属东方医院内镜中心,上海200120 [4]复旦大学附属中山医院普外科,上海200032 [5]湖北省肿瘤医院胃肠外科,武汉430070 [6]吉林大学第一医院胃结直肠肛门外科,长春130000 [7]福建省肿瘤医院胃肠肿瘤外科,福州350011 [8]厦门大学附属中山医院胃肠外科,厦门361000 [9]山东大学齐鲁医院胃肠外科,济南250000 [10]陆军军医大学新桥医院普外科,重庆400000 [11]四川省肿瘤医院大肠癌外科,成都610000 [12]浙江大学医学院附属第二医院肿瘤外科,杭州310000 [13]郑州大学第一附属医院结直肠肛门外科,郑州450000 [14]中南大学湘雅医院肝胆外科,长沙410000 [15]中南大学湘雅二医院胃肠外科,长沙410000 [16]浙江省肿瘤医院结直肠外科,杭州310000 [17]安徽医科大学第二附属医院普外科,合肥230000 [18]西安交通大学医学院第一附属医院普外科,710000 [19]南昌大学第一附属医院普外科,330000 [20]山西省肿瘤医院结直肠肛门外科,太原030000 [21]中山大学附属第六医院结直肠肛门外科,广州510000

出　　处：《中华结直肠疾病电子杂志》2021年第2期122-131,共10页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：中国医学科学院医学与健康科技创新工程项目(No.2016-I2M-1-001);北京市科技计划(No.D171100002617004)。

摘　　要：目的了解目前我国经自然腔道取标本手术(NOSES)开展现状,分析其主要优势与面临的挑战,为未来发展提供有力依据。方法2020年11~12月选取全国范围内从事胃肠外科、普通外科、妇科等专业的医师作为调查主要对象。本调查从医师的基本信息、开展NOSES现状、NOSES优势与挑战、NOSES教学培训及科研现状四方面进行问卷调查。结果本研究共有830人填写问卷,剔除18份无效问卷,共计812份有效问卷调查,有效问卷占比为97.8%,其中,开展NOSES人数占69.3%。本次调查覆盖我国30个省份及直辖市地区,其中29个地区均有医师已经开展NOSES,开展NOSES医院共373家。随时间推移,我国NOSES开展呈显著上升趋势,但各省及直辖市地区的开展情况差异较大。本次调查结果显示,我国目前开展NOSES总例数为20799,其中结直肠肿瘤占85.8%。对于结直肠肿瘤NOSES分析发现,经肛门取标本占85.7%;经阴道取标本占14.3%。本调查结果显示,85.3%(480/563)的医师认为改善术后恢复期心理情绪是NOSES最大优势,52.8%(297/563)的医师认为无菌无瘤把控仍然是NOSES面临最主要的挑战。针对NOSES培训学习调查结果显示,参加学术会议、专家手术直播演示和网络手术视频学习分别占比89.9%(506/563)、78.9%(444/564)和77.8%(438/563),40.0%(225/563)的医师表示学习NOSES最佳方式为参加培训班。关于NOSES科研调查结果显示,15.1%(85/563)的医师发表过NOSES相关论文,65.7%(370/563)和27.9%(157/563)开展的NOSES数据未上传或部分上传到中国NOSES数据库。结论我国NOSES发展趋势显著,地域分布广泛,推广潜力巨大。但规范化手术培训和临床科研产出仍有待进一步提升,下一步需要更加针对性的措施来完善NOSES发展体系,促进其更加科学规范、健康有序发展。Objective To understand the current situation of natural orifice specimen extraction surgery(NOSES)in China,and to analyze its main advantages and challenges,so as to provide a powerful basis for future development.Methods From November to December 2020,doctors engaged in gastrointestinal surgery,general surgery and gynecology were selected as the main subjects.This survey was conducted from four aspects:the basic information of doctors,the current situation of NOSES,the advantages and challenges of NOSES,the teaching and training of NOSES and the current situation of scientific research.Results In this study,a total of 830 doctors filled out questionnaires,18 invalid questionnaires were excluded,and a total of 812 valid questionnaires were investigated.the proportion of valid questionnaires was 97.8%,of which the number of people carrying out NOSES accounted for 69.3%.This survey covers 30 provinces and municipalities directly under the Central Government in China,of which29 regions have doctors who have carried out NOSES,and carried out NOSES in a total of 373 hospitals.With the passage of time,the development of NOSES in China shows a significant upward trend,but there are great differences among provinces and municipalities directly under the Central Government.The results of this survey show that the total number of NOSES cases in China is 20,799,of which colorectal tumors account for 85.8%.NOSES analysis of colorectal tumors showed that transanal sampling accounted for 85.7%and transvaginal sampling accounted for 14.3%.The results of this survey showed that 85.3%(480/563)of the physicians thought that improving the psychological mood during the postoperative recovery period was the greatest advantage of NOSES,and 52.8%(297/563)believed that aseptic and tumor-free control was still the main challenge for NOSES surgery.According to the survey results of NOSES training and learning,attending academic conferences,live demonstrations of experts in surgery and online surgery video learning accounted for 89.9%(506

关 键 词：结直肠癌 问卷调查 经自然腔道取标本手术(NOSES) 医师 开展现状 

分 类 号：R735.34[医药卫生—肿瘤]