中国经自然腔道取标本手术开展现状分析

An investigation report on the current situation of natural orifice specimen extraction surgery in China

目的了解目前我国经自然腔道取标本手术(NOSES)开展现状,分析其主要优势与面临的挑战,为未来发展提供有力依据。方法2020年11~12月选取全国范围内从事胃肠外科、普通外科、妇科等专业的医师作为调查主要对象。本调查从医师的基本信息、开展NOSES现状、NOSES优势与挑战、NOSES教学培训及科研现状四方面进行问卷调查。结果本研究共有830人填写问卷,剔除18份无效问卷,共计812份有效问卷调查,有效问卷占比为97.8%,其中,开展NOSES人数占69.3%。本次调查覆盖我国30个省份及直辖市地区,其中29个地区均有医师已经开展NOSES,开展NOSES医院共373家。随时间推移,我国NOSES开展呈显著上升趋势,但各省及直辖市地区的开展情况差异较大。本次调查结果显示,我国目前开展NOSES总例数为20799,其中结直肠肿瘤占85.8%。对于结直肠肿瘤NOSES分析发现,经肛门取标本占85.7%;经阴道取标本占14.3%。本调查结果显示,85.3%(480/563)的医师认为改善术后恢复期心理情绪是NOSES最大优势,52.8%(297/563)的医师认为无菌无瘤把控仍然是NOSES面临最主要的挑战。针对NOSES培训学习调查结果显示,参加学术会议、专家手术直播演示和网络手术视频学习分别占比89.9%(506/563)、78.9%(444/564)和77.8%(438/563),40.0%(225/563)的医师表示学习NOSES最佳方式为参加培训班。关于NOSES科研调查结果显示,15.1%(85/563)的医师发表过NOSES相关论文,65.7%(370/563)和27.9%(157/563)开展的NOSES数据未上传或部分上传到中国NOSES数据库。结论我国NOSES发展趋势显著,地域分布广泛,推广潜力巨大。但规范化手术培训和临床科研产出仍有待进一步提升,下一步需要更加针对性的措施来完善NOSES发展体系,促进其更加科学规范、健康有序发展。

Objective To understand the current situation of natural orifice specimen extraction surgery(NOSES)in China,and to analyze its main advantages and challenges,so as to provide a powerful basis for future development.Methods From November to December 2020,doctors engaged in gastrointestinal surgery,general surgery and gynecology were selected as the main subjects.This survey was conducted from four aspects:the basic information of doctors,the current situation of NOSES,the advantages and challenges of NOSES,the teaching and training of NOSES and the current situation of scientific research.Results In this study,a total of 830 doctors filled out questionnaires,18 invalid questionnaires were excluded,and a total of 812 valid questionnaires were investigated.the proportion of valid questionnaires was 97.8%,of which the number of people carrying out NOSES accounted for 69.3%.This survey covers 30 provinces and municipalities directly under the Central Government in China,of which29 regions have doctors who have carried out NOSES,and carried out NOSES in a total of 373 hospitals.With the passage of time,the development of NOSES in China shows a significant upward trend,but there are great differences among provinces and municipalities directly under the Central Government.The results of this survey show that the total number of NOSES cases in China is 20,799,of which colorectal tumors account for 85.8%.NOSES analysis of colorectal tumors showed that transanal sampling accounted for 85.7%and transvaginal sampling accounted for 14.3%.The results of this survey showed that 85.3%(480/563)of the physicians thought that improving the psychological mood during the postoperative recovery period was the greatest advantage of NOSES,and 52.8%(297/563)believed that aseptic and tumor-free control was still the main challenge for NOSES surgery.According to the survey results of NOSES training and learning,attending academic conferences,live demonstrations of experts in surgery and online surgery video learning accounted for 89.9%(506/563),78.9%(444/564)and 77.8%(438/563),respectively.40.0%(225/563)of physicians said that the best way to learn NOSES was to participate in the training course.The results of the scientific research survey on NOSES show that 15.1%(85/563)of doctors have published NOSES-related papers,and 65.7%(370/563)and 27.9%(157/563)of NOSES data have not been uploaded or partially uploaded to China’s NOSES database.Conclusions The present situation of NOSES development in China shows a significant development trend,wide regional distribution and great potential for popularization.However,standardized surgical training and clinical scientific research output still need to be further improved.In the next step,more targeted measures are needed to improve the NOSES development system and promote its more scientific,standardized,healthy and orderly development.