摘要
目的探索多学科会诊(MDT)综合管理模式在早期肺癌诊疗中的应用,分析其临床价值以及推广的可行性和意义。方法回顾性纳入西京医院2018年1月8日至2019年12月31日经MDT后进行手术的470例患者,其中男172例,女298例,年龄23~79(54.46±11.08)岁。分析基本诊疗信息以及术后病理,其中MDT建议手术441例,主观要求手术29例。比较患者一般情况、术前诊断以及病理结果,总结MDT综合管理模式的具体内容及相关技术运用。同时结合当下国内肺癌发病现状探究MDT综合管理模式在早期肺癌诊疗中的应用价值。结果470例手术患者中,男性以实性结节居多(69/172,40.1%),女性以磨玻璃结节居多(135/298,45.3%),结节分布总体呈现上叶(277/470)多于下叶(161/470)、右肺(276/470)多于左肺(194/470)的趋势。MDT推荐手术的441例患者中98.11%的男性(156/159)和97.87%的女性(276/282)术后病理提示恶性,腺癌为主要病理类型(男146/156例,93.59%;女269/276例,97.46%)。恶性病理结果中以原位癌(男66/156例,42.31%;女130/276例,47.10%)及Ⅰ期肺癌(男79/156例,50.64%;女131/276例,47.46%)居多。推荐手术的患者中1.89%的男性(3/159)和2.13%的女性(6/282)术后病理提示良性,其中以肺结核和真菌感染为主(各性别均为66.67%,男2/3例;女4/6例)。主观手术的29患者术后病理也以结核与真菌感染为主要类型(男9/13例,69.23%;女11/16例,68.75%)。MDT综合管理模式中充分联合运用多种辅助诊断技术,同时结合多学科参与的经验优势,弥补了单科诊断的局限性,总体诊断符合率可达98.09%,一致性强(Kappa>0.81),其阳性预测值(PPV)为97.96%,阴性预测值(NPV)为100%,患者诊疗周期均值为24.28~26.51 d。结论MDT综合管理模式符合共识要求,其在诊断效能和诊疗周期方面都具有较大的优势,对于早期肺癌的诊治具有较高的推广应用价值,但在早期肺癌的诊疗中应将结核与真菌的感染应作为重要鉴别诊断项目。
Objective To explore the application of multidisciplinary treatment(MDT)and comprehensive management model in the diagnosis and treatment of early-stage lung cancer,and analyze its clinical value and the feasibility and significance of promotion.Methods A retrospective study of 470 patients in Xijing Hospital who underwent surgery after MDT from January 8,2018 to December 31,2019.There were 172 males and 298 females,aged from 23 to 79(54.46±11.08)years.Basic diagnosis and treatment information as well as postoperative pathology were analyzed,of which 441 cases were recommended for surgery by MDT and 29 cases were subjectively requested for surgery.The patients′general condition,preoperative diagnosis and pathological results were compared,and the specific content of the MDT and comprehensive management model were summarized.We also explored the value of MDT integrated management model in early stage lung cancer treatment in the context of the current lung cancer incidence in China.Results Among 470 surgical patients,the majority of males had solid nodules(69/172,40.1%),and the majority of females had ground glass nodules(135/298,45.3%).The distribution of nodules showed a trend of more upper lobe(277/470)than lower lobe(161/470)and more right lung(276/470)than left lung(194/470).Among the 441 patients recommended for surgery,98.11%of males(156/159)and 97.87%of females(276/282)showed malignant pathology after surgery.Adenocarcinoma was the main pathological type(93.59%of males,146/156;97.46%of females,269/276).Among the malignant pathological results,carcinoma in situ(42.31%of males,66/156;47.10%of females,130/276)and stage I lung cancer(50.64%of males,79/156;47.46%of females,131/276)were the most common.In all patients,1.89%of the males(3/159)and 2.13%of the females(6/282)recommended for surgery showed benign postoperative pathology,of which tuberculosis and fungal infection were the main pathological types(66.67%for each gender,males 2/3,females,4/6).The postoperative pathology of 29 patients who subjectively requested surgery was also tuberculosis and fungal infection as the main pathological types(69.23%of males,9/13;68.75%of females,11/16).The MDT comprehensive management model made full use of a variety of auxiliary diagnostic technologies and combined the experience advantages of multidisciplinary participation to make up for the limitations of single-diagnosis.The overall diagnosis coincidence rate reached 98.09%,with strong consistency(Kappa>0.81).The positive predictive value(PPV)was 97.96%,the negative predictive value(NPV)was 100%,and the average patient diagnosis and treatment cycle was 24.28-26.51 days.Conclusions The MDT comprehensive management model meets the consensus requirements.It has great advantages in diagnostic efficiency and diagnosis and treatment cycle,and has a high promotion and application value for the diagnosis and treatment of early-stage lung cancer.At the same time,tuberculosis and fungal infection should be regarded as an important differential diagnosis item.
作者
杨雯晖
许天齐
张勇
张艳
席杭天
杨庭义
张艰
Yang Wenhui;Xu Tianqi;Zhang Yong;Zhang Yan;Xi Hangtian;Yang Tingyi;Zhang Jian(Department of Pulmonary Medicine,Xijing Hospital,Air Force Medical University,Xi′an 710000,China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2022年第3期261-268,共8页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
2017年陕西省研发重点计划(2017ZDXM-SF-044)
2018年西京医院学科助推计划(XJZT18MDT26)。
关键词
早期肺癌
MDT
管理模式
医疗服务
应用探索
Early Lung Cancer
MDT
Management Model
Medical Service
Application Exploration
作者简介
通信作者:张艰,Email:13991802890@163.com。
