多学科专家组诊疗模式在基层医院肿瘤诊疗中的实践

The practice of multidisciplinary team model in cancer diagnosis and treatment in the primary hospitals

目的分析基层医院肿瘤多学科专家组（multidisplinary team，MDT）模式的开展现状。方法回顾性分析2013年6月至2015年7月河北省南皮县人民医院肿瘤MDT讨论决策和执行情况。结果共251例肿瘤患者进入了MDT讨论。对其中初诊的233例患者形成MDT决策，执行决策的159例，达到预期目的118例（74．2％），未达到预期目的41例（25．8％）；未执行决策的74例，达到预期目的11例（14．9％），未达到预期目的63例（85．1％），两者相比差异有统计学意义（X2=71．97，P〈0．01）。实施MDT前后恶性肿瘤患者超声介入活检、CT增强扫描、CT引导穿刺、术中冰冻病理检查率相比差异均有统计学意义（均P〈0．05）。实施MDT前后年度新农合恶性肿瘤患者转诊率下降，差异有统计学意义（X2=19．86，P〈0．01）。结论MDT诊疗模式能使肿瘤患者和所在医院的医生获得更多的收益，是值得大力推广的肿瘤诊疗工作模式。

Objective To introduce and analyze the status of tumor multidisciplinary team （MDT） model application in primary hospitals. Methods MDT discussion decision-making and implementation of Nanpi People＇s Hospital from June 2013 to July 2015 were retrospectively analyzed. Results A total of 251 cases were recruited into the MDT discussion. Among them, 233 primarily diagnosed cases reached MDT decision-making and 159 cases took the decision, 118 cases achieved the purpose （74. 2% ） , 41 cases failed （25.8%）. Yet in 74 cases not following the decision, 11 cases achieved the desired purpose （14.9%）, while 63 cases didn＇t meet the desired purpose （85.1%）, the difference was statistically significant （X2 = 71.97, P 〈 0. 01 ）. Ultrasound interventional biopsy, enhanced CT scan, CT guided puncture., intraoperative frozen section examination in malignant tumor patients had significantly increased after MDT applied, the difference was statistically significant （ all P 〈 0. 05 ） . The annual new rural cooperative medical system referral rate in malignant tumor patients dropped sharply （X2 = 19.86, P 〈 0. 01 ） Conclusions Doctors and cancer patients can benefit from MDT diagnosis and treatment model, which is worth generalization.