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[近端胃切除术与消化道重建:中国外科医生的认知现状与治疗选择调查]

[Proximal gastrectomy and digestive tract reconstruction: status survey of perceptions and treatment selection in Chinese surgeons].

作者信息

Li Z G, Dong J H, Huang Q X, Tao K, Ma J, Zhang W H

机构信息

Department of Minimal Invasive Digestive Surgery, Shanxi Tumor Hospital, Shanxi Medical University, Taiyuan, Shanxi 030013, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Aug 25;23(8):757-765. doi: 10.3760/cma.j.cn.441530-20191226-00526.

Abstract

To understand the perceptions, attitudes and treatment selection of Chinese surgeons for proximal gastrectomy (PG) and digestive tract reconstruction. A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade IIIA (provincial and prefecture-level) tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2) Surgeons with senior attending physician, associate chief physician and chief physician. The "Questionnaire Star" platform was used to design a questionnaire about cognition, attitude and treatment choice of "proximal gastrectomy and digestive tract reconstruction". The questionnaire contained 32 questions, such as the basic information of surgeons, the current status of gastric cancer surgery, the selection and management of surgical methods and related details for proximal gastric cancer, the choice of proximal gastrectomy and reconstruction of digestive tract, the related complications and nutritional status monitoring after proximal gastrectomy. A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25, 2019. Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables. A total of 47 grade IIIA hospitals were included, and 76 questionnaires were sent out. The proportions of recovered and valid questionnaires were both 100%. For early and middle stage adenocarcinoma of esophagogastric junction (AEG), especially those smaller than 4 cm, 72.37% (55/76) of surgeons preferred proximal gastrectomy, while 22.37% (17/76) of surgeons chose total gastrectomy. For early AEG, 90.79% (69/76) of surgeons thought that endoscopic submucosal dissection (ESD) or proximal gastrectomy could be considered. For AEG below T3 stage and shorter than 4 cm, 60.53% (46/76) of surgeons gave priority to proximal gastrectomy, and 60.53% (46/76) of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy, and the residual stomach should not be less than half stomach. Considering anti-reflux effect, postoperative weight recovery, clinical efficacy, wide application and easy popularization, surgeons preferred double-tract reconstruction. The surgeons in tumor hospitals had a higher approval rate for the application of proximal gastrectomy and the fact that the Kamikawa anastomosis was the most difficult to promote than the surgeons in provincial/municipal general hospitals. The surgeons with an annual surgical volume of more than 200 were more likely to choose proximal gastrectomy for early and middle stage AEG patients and the proportion was as high as 8/9. From the perspective of good clinical results, wide range of application, and easy popularization, the surgeons with a higher ratio (60.00%, 15/25) of double-tract reconstruction were those surgeons with 50-100 operations per year. The general level of cognition and acceptability of Chinese surgeons for proximal gastrectomy and reconstruction of digestive tract is suboptimal. In the future, it is urgent to promote the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy" so as to guide and optimize treatment in proximal gastric cancer.

摘要

了解中国外科医生对近端胃切除术(PG)及消化道重建的认知、态度和治疗选择。本研究采用横断面调查。研究对象选择:(1)国内公立三级甲等(省、地级)肿瘤医院或具备胃癌诊疗资质的综合医院。(2)具有副主任医师、主任医师职称的外科医生。采用“问卷星”平台设计关于“近端胃切除术及消化道重建”的认知、态度及治疗选择的问卷。问卷包含32个问题,如外科医生的基本信息、胃癌手术现状、手术方式的选择及处理以及近端胃癌的相关细节、近端胃切除术及消化道重建的选择、近端胃切除术后的相关并发症及营养状况监测等。2019年7月29日至8月25日期间,通过微信共向76名受访者发送问卷。分类变量采用卡方检验或Kruskal-Wallis检验进行统计分析。共纳入47家三级甲等医院,发放问卷76份。回收问卷和有效问卷比例均为100%。对于食管胃交界部早期和中期腺癌(AEG),尤其是直径小于4 cm者,72.37%(55/76)的外科医生首选近端胃切除术,而22.37%(17/76)的外科医生选择全胃切除术。对于早期AEG,90.79%(69/76)的外科医生认为可考虑内镜黏膜下剥离术(ESD)或近端胃切除术。对于T3期以下且直径小于4 cm的AEG,60.53%(46/76)的外科医生优先选择近端胃切除术,60.53%(46/76)的外科医生认为根治性更高的进展期AEG应行近端胃切除术,残胃不应少于半胃。考虑到抗反流效果、术后体重恢复、临床疗效、广泛应用及易于推广,外科医生更倾向于双通道重建。肿瘤医院的外科医生对近端胃切除术的应用及“金井吻合术最难推广”这一事实的认可率高于省/市级综合医院的外科医生。年手术量超过200例的外科医生更倾向于为早期和中期AEG患者选择近端胃切除术,比例高达8/9。从临床效果好、应用范围广及易于推广的角度来看,双通道重建比例较高(60.00%,15/25)的外科医生是每年手术量为50 - 100例的医生。中国外科医生对近端胃切除术及消化道重建的总体认知和接受程度欠佳。未来,亟待推广“近端胃切除术后消化道重建中国专家共识”,以指导和优化近端胃癌的治疗。

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