多学科协作模式在高龄胆总管结石ERCP围手术期全程管理中的应用  

Application of multidisciplinary diagnosis and treatment in perioperative management of endoscopic retrograde cholangiopancreatography in elderly patients with choledocholithiasis

作　　者：赵睿婷 闫翔 庞勇 ZHAO Ruiting;YAN Xiang;PANG Yong(Second Department of Cadre's Ward,General Hospital of Western Theater Command,PLA,Chengdu 610083,Sichuan,China;Department of Hepatobiliary Surgery,General Hospital of Western Theater Command,PLA,Chengdu 610083,Sichuan,China)

机构地区：[1]西部战区总医院干部病房二科,成都610083 [2]西部战区总医院肝胆外科,成都610083

出　　处：《医学研究与战创伤救治》2023年第6期585-589,共5页Journal of Medical Research & Combat Trauma Care

基　　金：四川省自然科学基金(23NSFSC0240)。

摘　　要：目的探讨多学科协作模式(MDT)在高龄胆总管结石内镜下逆行性胰胆管造影(ERCP)围手术期全程管理中的应用效果。方法回顾性分析2014年1月1日至2021年12月31日于西部战区总医院行ERCP手术的80岁以上胆总管结石患者的临床资料,以MDT团队正式实施时间2018年1月1日为界分为传统诊疗组59例和MDT组33例,比较2组手术相关指标、住院相关指标、围手术期并发症、医护满意度等。结果MDT组住院时间(7.97±3.06)d,较传统诊疗组时间(10.13±3.54)d更短(P<0.01);诊疗费用(30084.03±5714.09)元,较传统诊疗组(34252.76±10474.79)元更低(P<0.05);围手术期出血发生率[3.03%(1/33)]及高淀粉酶血症发生率[6.06%(2/33)]明显低于传统诊疗组[13.60%(8/59)、22.03%(13/59)],差异有统计学意义(P<0.05)。结论MDT模式应用于高龄胆总管结石ERCP围手术期的全程管理,在缩短手术时间、减少诊疗费用,减少并发症,提高患者满意度等方面均取得明显进步。Objective To discuss the application effect of multidisciplinary diagnosis and treatment(MDT)in the perioperative management of endoscopic retrograde cholangiopancreatography(ERCP)in elderly patients with choledocholithiasis.Methods The clinical data of patients over 80 years old who underwent ERCP surgery in the General Hospital of Western Theater Command from January 1,2014 to December 31,2021 were retrospectively analyzed.According to the official implementation time of the MDT team on January 1,2018,there were 59 cases in the traditional treatment group and 33 cases in the MDT group.The indexes related to surgery,hospitalization,perioperative complications and medical satisfaction were compared between the two groups.Results The length of hospital stay in MDT group was shorter(7.97±3.06)d than that in traditional treatment group(10.13±3.54)d(P<0.01).The cost of diagnosis and treatment was(30084.03±5714.09)yuan,which was lower than that of traditional treatment group(34252.76±10474.79)yuan(P<0.05).The incidence of perioperative hemorrhage[3.03%(1/33)]and hyperamylasemia[6.06%(2/33)]were significantly lower than those in the traditional treatment group[13.60%(8/59)and 22.03%(13/59)],and the differences were statistically significant(P<0.05).Conclusion The application of MDT in the perioperative management of ERCP in elderly patients with choledocholithiasis has made significant progress in shortening operation time,reducing diagnosis and treatment costs,reducing complications and improving patient satisfaction.

关 键 词：多学科协作模式 高龄胆总管结石 内镜下逆行性胰胆管造影 

分 类 号：R575.7[医药卫生—消化系统]