中国结直肠外科医师对直肠癌保肛手术排粪功能保护相关的诊疗现状调查  

Investigation on the status quo of diagnosis and treatment related to the protection of defecation function in sphincter-preserving resections for rectal cancer:a cross-sectional study of Chinese colorectal surgeons

作　　者：侯森 刘凡[1] 申占龙[1,2,3] 叶颖江 Hou Sen;Liu Fan;Shen Zhanlong;Ye Yingjiang(Department of Gastrointestinal Surgery,Peking University People's Hospital,Beijing 100044,China;Mboratory of Surgical Oncology.Peking University Peopled Hospital,Beijing 100044.China;Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科,100044 [2]北京大学人民医院外科肿瘤实验室,100044 [3]北京市结直肠癌诊疗研究重点实验室,100044

出　　处：《中华胃肠外科杂志》2021年第4期319-326,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81871962);国家重点研发计划(2145000042)。

摘　　要：目的了解我国结直肠外科医师对直肠癌保肛手术(SPR)排粪功能保护相关的诊疗现状,以发现结直肠外科医师群体在SPR功能保护中存在的问题,为直肠癌的规范化临床管理提供支持和依据。方法采用横断面调查方法。纳入取得执业医师资格证书并自愿参加本调查研究的结直肠外科医师,排除信息填写不全的调查对象。于2020年10月18—22日期间,采取便利抽样的方法,对中国医师协会结直肠外科医师委员会、中国医师协会结直肠肿瘤专业委员会、中国性学会结直肠外科肛门功能外科分会和国家卫生健康委员会能力建设和继续教育外科专家委员会成员所在医院的结直肠外科医师以发放电子问卷的方式进行抽样调查。问卷包括调查对象基本信息和执业情况、SPR术前排粪功能评估、术中操作现状以及术后随访情况和对低位前切除综合征(LARS)患者的评估和干预情况。观察指标为问卷调查结果。结果共采集问卷231份,有效问卷230份,有效率99.6%。受访者中男性217人(94.3%),107位(46.5%)受访者最高学历为博士学位,129人(56.1%)有国家级结直肠外科学术职务,137人(59.6%)每年完成50例以上SPR手术。211人(91.7%)使用客观检查评估患者术前排粪功能,直肠乙状结肠镜(116人,55.0%)和直肠肛管测压(81人,38.4%)是最常使用的方式。64.8%(149/230)受访医师最常使用2D腹腔镜进行SPR手术,51.3%(118/230)采用结肠肛管直接吻合进行肠道重建,98.3%(226/230)的医师在吻合过程中使用吻合器。所有受访医师均表示会对SPR术后的患者进行随访,门诊随访是最常用的方式(84.4%,184/230)。当患者出现LARS时,115人(50%)选用排粪功能量表进行评估,181人(78.7%)总是对LARS患者进行指导干预。结论我国结直肠外科医师对于直肠癌SPR排粪功能的保护仍然存在短板,对患者术前功能评估和术后功能恢复预估不够,对排粪功能量表的认知和�Objective To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections(SPR)for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer.Methods A cross-sectional survey was performed.Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included,and respondents with incomplete information were excluded.From October 18 to 22,2020,randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons,Chinese Colorectal Cancer Committee,Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee.The questionnaire included basic information of the respondents,assessment of defecation function before SPR,intraoperative details,postoperative follow-up,evaluation and intervention of patients with low anterior resection syndrome(LARS).Observation indicator:results of the questionnaire survey.Result A total of 231 questionnaires were collected,and 230 were effective,with an effective rate of 99.6%.Among these participants,217(94.3%)were males;107(46.5%)had medical doctor degrees;129(56.1%)were national commission members in colorectal surgery;137(59.6%)performed more than 50 SPR operations per year;211(91.7%)assessed defection function by auxiliary examinations before SPR.Rigid sigmoidoscopy(n=116,55.0%)and anorectal manometer(n=81,38.4%)were the most commonly used method.Among the 230 respondents,64.8%(n=149)of surgeons used 2D laparoscopy for SPR surgery most commonly,and 51.3%(n=118)of surgeons performed direct colorectal anastomosis for reconstruction,and 98.3%(n=226)used staplers during anastomosis.All the surgeons indicated that they would follow up patients after SPR,and outpatient clinic was th

关 键 词：直肠肿瘤 保肛手术 功能保护 现况调查 

分 类 号：R735.37[医药卫生—肿瘤]