中国结直肠外科医师执业现状及观念调查报告

A cross-sectional study on the occupational status and concept of colorectal surgeons in China

目的调查中国结直肠外科医师的执业现状及观念。方法自2014年1月至2015年1月,对北京大学人民医院、北京大学肿瘤医院、同济大学附属东方医院、复旦大学附属中山医院、浙江大学医学院附属第二医院、中山大学附属第六医院、山东省立医院、兰州大学第二医院、中南大学湘雅医院、中国医学科学院肿瘤医院等105家医院的结直肠外科医师发放统一的调查表。结果回收有效调查表共660份。(1)一般状况:被调查者95.3%为男性,年龄>30岁者占91.2%,最高学历为博士研究生者占26.5%,三级医院执业者占76.7%,结直肠外科执业年限>5年者占72.7%。(2)执业现状:调查医师所在科室总床位数的中位数为52张,其中收治结直肠疾病病人的床位数为30张;科室年中位手术量900例,结直肠疾病手术200例;科室手术医师数量的中位数为8名,结直肠专业手术医师6名。调查医师每年中位手术量250例,结直肠疾病手术80例;调查医师年结肠疾病手术量的中位数为50例,其中开放手术62.5%、腹腔镜手术31.3%;调查医师年直肠疾病手术量的中位数为40例,其中开放手术50.0%、腹腔镜手术47.5%。(3)执业观念:有76.6%的结直肠外科医师认为有必要掌握内镜技术,然而只有26.3%的结直肠外科医师掌握软式结肠镜检查技术,11.4%掌握内镜手术(内镜下黏膜切除术或内镜下黏膜剥离术)技术。对于早期结直肠癌、局部进展期结直肠癌、可切除的结直肠癌肝转移、不可切除的结直肠癌肝转移病人,分别有19.7%、33.8%、46.2%、59.1%的结直肠外科医师认为治疗决策权属于多学科综合治疗协作组(multidiciplinary team,MDT)。结论我国结直肠外科医师专业化程度尚需提高;新的诊疗手段及观念如微创技术、内镜技术及MDT观念仍须进一步推广和加强。

Objective To assess the occupational status and concept of colorectal surgeons in China. Methods Thiswas a cross-sectional study using convenience sampling to collect data through questionnaire among colorectal surgeons in China. Results A total of 660 effective questionnaire was received,（1） general status： 95.3% were male, 91.2% were more than 30 years old, 26.5% had a M.D. degree, 76.7% worked in a tertiary hospital and 72.7% had pursued an occupation on colorectal surgery more than 5 years. （2） occupational status： the median of total inpatients of department were 52 and the median of colorectal inpatients of department were 30; the median cases of total surgery per year of department were 900 and the median cases of colorectal surgery per year of department were 200; the median of total surgeons of department were 8 and the median of colorectal surgeons of department were 6; the median cases of total surgery per year of participant was 250 and the median cases of colorectal surgery per year of participant was 80; the median cases of colon surgery per year of participant was 50 and 62.5% were open surgery, 31.3% were laparoscopic surgery; the median cases of rectal surgery per year of participant was 50 and 50.0% were open surgery, 47.5% were laparoscopic surgery. （3） occupational concept： Out of 660 participants, 76.6% agreed colorectal surgeons should master endoscopy, 26.3% mastered endoscopy, only 11.4% mastered EMR/ESD. For early colorectal cancer, advanced colorectal, resectable liver metastasis of colorectal cancer, unresectable liver metastasis of colorectal cancer, there were 19.7% . 33.8% . 46.2% . 59.1% participants agreed multidiciplinaryteam had decision-making power in treatment. Conclusion Colorectal surgeons of China still need to strengthen specialization. Some new technology and concept such as minimally invasive technique, endoscopic technique, multidiciplinaryteam still need to be extension.