摘要
目的了解胰腺肿瘤诊治中心多学科诊疗(MDT)门诊对胰腺疾病的诊断价值及患者的依从性.方法回顾性分析2015年5月至2019年5月复旦大学附属中山医院胰腺肿瘤MDT门诊接诊的512例患者的临床及病理学资料.根据WHO 2010消化系统肿瘤分类和临床诊疗常规对入组病例进行分类.依从性的判定根据患者是否依照MDT诊疗建议于我院接受治疗、进一步检查或随访.结果MDT门诊接诊的512例患者中,因诊断不明提交讨论121例,按最后诊断追溯,诊断不明病例的比例依次为胰腺炎性疾病(75.0%,24/32)、其他疾病(56.1%,23/41)、胰腺囊性疾病(19.1%,17/89)、胰腺癌(18.3%,48/262)、胰腺神经内分泌肿瘤(pNEN)(10.2%,9/88).MDT门诊对其中68例做出直接诊断,诊断正确率为89.7%.MDT门诊患者的总体依从率为63.4%,2017年6月至2019年5月患者的依从率(68.4%)较2015年5月至2017年5月(59.6%)有所提高.依从率由高至低的疾病依次为胰腺炎性疾病(84.4%,27/32)、胰腺癌(67.9%,178/262)、pNEN(60.2%,53/88)、其他疾病(56.1%,23/41)、胰腺囊性疾病(49.4%,44/89).依从率由高至低的MDT诊疗建议依次为对症支持治疗(78.6%,22/28)、其他抗肿瘤治疗(71.6%,159/222)、进一步检查(62.6%,77/123)、手术治疗(53.7%,65/121)、随访(49.2%,31/63).在建议手术的患者中,胰腺癌患者的依从率(67.4%,33/49)最高.结论MDT门诊能够较为正确、便捷地诊断疑难胰腺病例.MDT门诊患者的总体依从率不高,胰腺癌患者对手术建议的依从性相对较好.
Objective To evaluate the role of multidisciplinary team(MDT)clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system.Methods The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively.Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices.Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups.Results Among the 512 patients that had visited the MDT clinic,121 patients were referred due to undetermined diagnosis.Classified according to the final diagnosis,the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas(75.0%,24/32),other lesions of the pancreas(56.1%,23/41),pancreatic cystic lesions(19.1%,17/89),pancreatic carcinomas(18.3%,48/262)and pancreatic neuroendocrine neoplasms(pNEN)(10.2%,9/88).The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%.The rate of compliance in the entire cohort was 63.4%.The rate of compliance of patients from June 2017 to May 2019(68.4%)was higher than that of patients from May 2015 to May 2017(59.6%).The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%,27/32),pancreatic carcinomas(67.9%,178/262),pNEN(60.2%,53/88),other lesions of the pancreas(56.1%,23/41),and pancreatic cystic lesions(49.4%,44/89).The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28),antitumor approaches beyond surgery(71.6%,159/222),further tests(62.6%,77/123),surgery(53.7%,65/121)and follow-up(49.2%,31/63).In patients suggested for surgery,the compliance rate of patients with carcinomas(67.4%,33/49)was higher than patients with other kinds of neoplasms.Conclusions MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively.The overall compliance rate of MDT clinic patients is rather low,and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.
作者
李剑昂
吴文川
纪元
刘凌晓
饶圣祥
王单松
张轶群
姚秀忠
范越
黄成
周宇红
楼文晖
Li Jian'ang;Wu Wenchuan;Ji Yuan;Liu Lingxiao;Rao Shengxiang;Wang Dansong;Zhang Yiqun;Yao Xiuzhong;Fan Yue;Huang Cheng;Zhou Yuhong;Lou Wenhui(Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China;Department of Pathology,Zhongshan Hospital Fudan University,Shanghai 200032,China;Department of Interventional Radiology,Zhongshan Hospital Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital Fudan Universityt Shanghai 200032,China;Endoscopy Center,Zhongshan Hospital Fudan University,Shanghai 200032,China;Department of Traditional Chinese Medicine,Zhongshan Hospital Fudan University,Shanghai 200032,China;Department of Liver Surgery,Zhongshan Hospital Fudan University Shanghai 200032,China;Department of Medical Oncology,Zhongshan Hospital Fudan University,Shanghai 200032,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2019年第12期912-916,共5页
Chinese Journal of Surgery
关键词
胰腺肿瘤
诊断
多学科诊疗门诊
胰腺疾病
患者依从性
Pancreatic neoplasms
Diagnosis
Multidisciplinary team clinic
Pancreatic diseases
Patient compliance
作者简介
通信作者:楼文晖,Email:lou.wenhui@zs-hospital.sh.cn,电话:18616881868。
