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目的调查中国结直肠外科医师的执业现状及观念。方法自2014年1月至2015年1月,对北京大学人民医院、北京大学肿瘤医院、同济大学附属东方医院、复旦大学附属中山医院、浙江大学医学院附属第二医院、中山大学附属第六医院、山东省立医院、兰州大学第二医院、中南大学湘雅医院、中国医学科学院肿瘤医院等105家医院的结直肠外科医师发放统一的调查表。结果回收有效调查表共660份。(1)一般状况:被调查者95.3%为男性,年龄>30岁者占91.2%,最高学历为博士研究生者占26.5%,三级医院执业者占76.7%,结直肠外科执业年限>5年者占72.7%。(2)执业现状:调查医师所在科室总床位数的中位数为52张,其中收治结直肠疾病病人的床位数为30张;科室年中位手术量900例,结直肠疾病手术200例;科室手术医师数量的中位数为8名,结直肠专业手术医师6名。调查医师每年中位手术量250例,结直肠疾病手术80例;调查医师年结肠疾病手术量的中位数为50例,其中开放手术62.5%、腹腔镜手术31.3%;调查医师年直肠疾病手术量的中位数为40例,其中开放手术50.0%、腹腔镜手术47.5%。(3)执业观念:有76.6%的结直肠外科医师认为有必要掌握内镜技术,然而只有26.3%的结直肠外科医师掌握软式结肠镜检查技术,11.4%掌握内镜手术(内镜下黏膜切除术或内镜下黏膜剥离术)技术。对于早期结直肠癌、局部进展期结直肠癌、可切除的结直肠癌肝转移、不可切除的结直肠癌肝转移病人,分别有19.7%、33.8%、46.2%、59.1%的结直肠外科医师认为治疗决策权属于多学科综合治疗协作组(multidiciplinary team,MDT)。结论我国结直肠外科医师专业化程度尚需提高;新的诊疗手段及观念如微创技术、内镜技术及MDT观念仍须进一步推广和加强。
Objective To investigate the current status and conception of Chinese colorectal surgeons. Methods From January 2014 to January 2015, we performed a comprehensive evaluation of Peking University People’s Hospital, Peking University Cancer Hospital, Dongfang Hospital affiliated to Tongji University, Zhongshan Hospital Affiliated to Fudan University, Second Affiliated Hospital of Zhejiang University Medical School, No. 6 Affiliated Hospital of Sun Yat- , Shandong Provincial Hospital, Lanzhou University Second Hospital, Xiangya Hospital of Central South University, Cancer Hospital of Chinese Academy of Medical Sciences and other 105 hospitals of colorectal surgeons issued a unified questionnaire. Results A total of 660 valid questionnaires were collected. (1) General situation: 95.3% of the respondents were male, 91.2% of them were aged 30, 26.5% of them had the highest academic record of doctoral students, 76.7% of doctors of tertiary hospitals and> 5 years of practice of colorectal surgery Accounted for 72.7%. (2) Status of practice: The median number of beds in the department where the investigating physician was located was 52, of which 30 were patients receiving colorectal diseases; 900 were mid-stage operations and 200 were those with colorectal diseases; The median number of department surgeons was 8, and 6 were specialist colorectal surgeons. The survey of physicians in each of the median annual surgery of 250 cases, 80 cases of colorectal disease surgery; survey of physicians annual colon disease surgery for the median of 50 cases, including open surgery 62.5%, laparoscopic surgery 31.3%; survey physician annual rectal surgery The median amount of 40 cases, of which 50.0% open surgery, laparoscopic surgery 47.5%. (3) Practice concept: 76.6% of colorectal surgeons think it is necessary to master the endoscopic technique. However, only 26.3% of the patients have mastectomy soft colonoscopy and 11.4% have undergone endoscopic surgery Resection or endoscopic mucosal dissection) technology. For early colorectal cancer, locally advanced colorectal cancer, resectable colorectal cancer liver metastases, unresectable colorectal cancer liver metastases, respectively, 19.7%, 33.8%, 46.2%, 59.1% of colorectal surgeons Therapeutic decision-making power is considered to belong to the multidisciplinary team (MDT). Conclusion The degree of specialization of colorectal surgeons needs to be improved in our country. New methods and concepts such as minimally invasive techniques, endoscopic techniques and MDT concepts still need to be further popularized and strengthened.