自然腔道内镜手术（NOTES）：患者的认知和态度。
Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes.
机构信息
Department of Gastroenterology and Hepatology, The Chinese People's Liberation Army General Hospital, Fuxing Road 28, 100853, Beijing, China.
出版信息
Dig Dis Sci. 2011 Aug;56(8):2415-22. doi: 10.1007/s10620-011-1797-5. Epub 2011 Jun 25.
BACKGROUND
Natural orifice translumenal endoscopic surgery (NOTES) has generated a surge of enthusiasm among researchers by virtue of its challenge to the dogma and potential benefits. However, no data is available in the medical literature about NOTES' acceptance by patients in Asia. The aim of the study is to survey patients' perceptions and attitudes towards NOTES.
METHODS
It is a questionnaire-based multi-center study on inpatient subjects with various gastrointestinal disorders from 14 hospitals in 12 cities of China. Procedural details with the benefits and risks of NOTES, laparoscopic surgery, and conventional surgery were explained to all registered candidates. They were required to choose and cite reasons for adopting one of the above three surgical techniques as the preferred mode of treatment. The reasons for selection of the surgical treatment were: safety, efficacy, cost, postoperative pain, abdominal wounds, and scarring.
RESULTS
There were 1,797 cases, including 976 (54.3%) males and 821 females (45.7%). Based on their comprehension of the procedure, 802 (44.6%) patients opted for NOTES, 757 (42.1%) for laparoscopic surgery, and 238 (13.2%) for conventional surgery. NOTES was mainly selected by the young and educated persons, especially females and by those with past exposure to laparoscopy or conventional surgery. The choice of treatment was significantly correlated with age (P=0.0021), education (P=0.0209), past medical history (laparoscopy, P=0.0134; open surgery, P<0.0001), and department of admission (P=0.0173). The preference for NOTES was based on safety (37.3%), cost (17.6%), elimination of postoperative scars (16.1%), abdominal wounds (16.0%), and efficacy (13.1%).
CONCLUSIONS
The vast majority of patients prefer mini-invasive surgery to conventional surgery. The potential recipients of NOTES are educated and younger age groups. However, a few consider NOTES as a safe and effective intervention at present.
背景
经自然腔道内镜外科（NOTES）对传统观念提出挑战，并具有潜在的益处，因此在研究人员中引起了极大的兴趣。然而，亚洲患者对 NOTES 的接受程度在医学文献中尚无相关数据。本研究旨在调查患者对 NOTES 的看法和态度。
方法
这是一项基于问卷的多中心研究，对象为来自中国 12 个城市的 14 家医院的各种胃肠道疾病住院患者。向所有登记的候选者详细说明 NOTES、腹腔镜手术和传统手术的程序细节、益处和风险。要求他们选择并引用采用上述三种手术技术之一作为首选治疗方式的原因。选择手术治疗的原因是：安全性、疗效、成本、术后疼痛、腹部伤口和疤痕。
结果
共有 1797 例患者，其中男性 976 例（54.3%），女性 821 例（45.7%）。基于他们对手术过程的理解，802 例（44.6%）患者选择 NOTES，757 例（42.1%）选择腹腔镜手术，238 例（13.2%）选择传统手术。NOTES 主要由年轻且受过教育的人、特别是女性以及有过腹腔镜或传统手术经历的人选择。治疗选择与年龄（P=0.0021）、教育程度（P=0.0209）、既往病史（腹腔镜检查，P=0.0134；开放性手术，P<0.0001）和入院科室（P=0.0173）显著相关。选择 NOTES 的主要原因是安全性（37.3%）、成本（17.6%）、消除术后疤痕（16.1%）、腹部伤口（16.0%）和疗效（13.1%）。
结论
绝大多数患者更喜欢微创手术而非传统手术。NOTES 的潜在接受者是受过教育且年龄较小的人群。然而，目前仍有少数人认为 NOTES 是一种安全有效的干预措施。
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