子宫颈癌患者手术质量管理分析  

Analysis of surgical quality management of cervical cancer patients

作　　者：饶群仙[1] 韦苑 刘畅浩[1] 林荣春[1] 林少丹[1] 陈青松 林仲秋[1] RAO Qun-xian;WEI Yuan;LIU Chang-hao;LIN Rong-chun;LIN Shao-dan;CHEN Qing-song;LIN Zhong-qiu(Department of Gynaecological Oncology,Sun Yat-sen Memorial Hospital,Sun Yatsen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院妇科肿瘤专科,广东广州510120 [2]广东药科大学公共卫生学院,广东广州510310

出　　处：《中国实用妇科与产科杂志》2021年第5期573-576,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金面上项目(81972433)。

摘　　要：目的探讨中山大学孙逸仙纪念医院子宫颈癌手术质量管理水平,评估优缺点,促进实施规范手术质量管理计划。方法借鉴《欧洲妇科肿瘤学会子宫颈癌手术治疗质量指标(2020版)》,对中山大学孙逸仙纪念医院妇科肿瘤专科2016年1月1日至2018年12月31日收治的子宫颈癌手术病例进行手术质控评估分析。结果所有手术均由具有四级手术资格的妇科肿瘤医生执行,中心工作量、医生经验指标[子宫颈癌广泛手术量(平均216例/年vs.≥30例/年)]、参与妇科肿瘤临床试验数量(10余项vs.≥1项)、指标随访率(99.72%vs.≥90%)、手术质量指标[术后尿瘘发生率(0.56%vs.≤3%);过去3年初次手术后阴道和双侧宫旁切缘阴性率(97.09%vs.≥97%);术前诊断<ⅡB期,术后肿瘤分期≥ⅡB期(不包括淋巴结转移)比例(0.57%vs.<10%);Ⅰ期(ⅠA1~ⅠB3)患者2年复发率(1.83%vs.<10%)]、Ⅰ期患者淋巴结切除率(98.58%vs.≥98%),保留生育功能方案告知及讨论率(100%vs.100%)等指标均达到欧洲妇科肿瘤学会子宫颈癌质控标准。全面管理质量指标[多学科联合会诊(MDT)参与方案制定与术前检查]、相关记录完善指标(病理报告)及是否遵从治疗标准的部分质量指标距离欧洲标准尚存差距。结论子宫颈癌手术管理及诊疗过程规范、手术数量可观,总体上与欧洲妇科肿瘤学会子宫颈癌质控标准一致,但仍需要进一步全面管理,完善相关手术记录,遵从国际诊治标准,严格规范手术质量控制管理工作。Objective Hospital,evaluating the advantages and disadvantages,in order to promote the implementation of standardized surgical quality management plan.Methods Society of Gynecological Oncology(2020 edition),the surgical quality control of the surgical cases of cervical cancer in the Gynecological Oncology Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 1,2016 to December 31,2018 was evaluated and analyzed.Results gynecologic oncologists with gradeⅣsurgical qualifications.There are 10 indicators that reach the quality control standard of cervical cancer of European Society of Gynecological Oncology including the center case load,experience of the surgeon[number of radical procedures in cervical cancer performed per year(mean 216 cases per year vs.≥30 cases per year)],number of participating in clinical trials of gynecological tumors(10 items vs.≥1 item),structured followup rate(99.72%vs.≥90.0%),surgical quality index[urological fistula rate(0.56%vs.≤3.0%),proportion of patients after primary surgical treatment who had clear vaginal and parametrial margins(97.09%vs.≥97%),proportion of preoperative diagnosis lower than stageⅡB and postoperative tumor stage higher than or equal to stageⅡB(excluding lymph node metastasis)(0.57%vs.<10.0%),the 2-year recurrence rate in stageⅠ(ⅠA1-ⅠB3)patients(1.83%vs.<10.0%)],lymph node excision rate in stageⅠpatients(98.58%vs.≥98%),counseling about a possibility of FST(100.0%vs.100.0%).Overall management quality indicators(MDT participation in protocol formulation and preoperative examination),related record improvement indicators(pathological reports),and some quality indicators of compliance of management with the standards were still lagging behind European standards.ConclusionThe surgical management and diagnosis and treatment process of cervical cancer in our hospital are standardized,and the number of surgeries is considerable and the quality of surgeries is in accordence with the standards of European Society of Gyneco

关 键 词：子宫颈肿瘤 手术治疗 质量管理指标 

分 类 号：R737.3[医药卫生—肿瘤]