基于医护合作的遗传性肠癌门诊的管理

The construction and implementation of hereditary colorectal cancer clinic based on physician-nurse collaboration

目的 :构建基于医护合作的遗传性肠癌门诊并评价其实践效果,以规范遗传性肠癌患者的管理、改善其亲属肿瘤防治的效果并推动遗传性肿瘤诊疗及研究的规范化发展。方法 :构建基于医护合作的遗传性肠癌门诊,由经过严格选拔并培训的1名结直肠外科主任医师和1名肿瘤专科护士出诊,规范了出诊医生及护士的资质和培训要求,确立接诊对象为有遗传性肠癌风险的患者及亲属。由护士预约、询问患者家族史并绘制家系图、收集患者及家属的诊治资料,主任医师接受就诊对象的遗传咨询。结果 :经过2年半的实践,共接诊502人次,收集并绘制家系图223个,确诊并随访管理遗传性肠癌家系120个;患者亲属中,检出携带高危风险基因52例,肠镜筛查检出肠癌5例,息肉8例。结论 :遗传性肠癌门诊的设立,使遗传性肠癌患者得以确诊,并提高高危亲属的基因检测及肿瘤筛查率,促进高危人群的早期诊断、早期治疗,为遗传性肿瘤门诊的构建提供了实践依据。

Objective: In order to improve the effect of prevention and treatment of cancer in patients with hereditary colorectal cancer and their families, our hospital has established a hereditary colorectal cancer clinic based on physician-nurse collaboration for patients with hereditary colorectal cancer and their families. Methods: A hereditary colorectal cancer clinic based on physician-nurse collaboration was established and operated by a qualified chief physician with perfect training of colorectal surgery department and a clinical nurse specialist of oncology department. Qualification and training requirements of the chief physician and the nurse specialist were normalized and patients with risk of hereditary colorectal cancer and their families were considered as targeted people. The nurse made an appointment, inquired the family history, drew the family diagram, and collected the diagnosis and treatment data of the patients and their families while the director offered genetic counseling. A series of working systems and management methods were developed. Results: During the two and a half years of practice, 502 person times visited the clinic and family diagrams were collected and drew for 223 families. Besides, 120 families with hereditary colorectal carcinoma were diagnosed and offered follow-ups. Among the blood relatives of the 120 hereditary colorectal cancer patients, 52 were found to carry high-risk genes, 5 cases were diagnosed as colorectal cancer by colonoscopy, and 8 cases were polyps. Conclusion: With the help of the clinic, gene detection and tumor screening rate of high-risk relatives has been improved. Furthermore, early detection and early treatment of high-risk groups being promoted provides a practical basis for the construction of the management model of hereditary tumors.