胃癌前病变的筛查和管理:一项基于消化科医生的横断面调查研究

Screening and management of gastric precancerous lesions:a cross-sectional survey study for gastroenterologists

目的:了解我国不同地区各级别医疗机构对胃癌前病变的筛查及专病管理情况。方法:2020年8月25日—2020年9月25日以线上问卷调查的形式对全国不同等级医疗机构消化专科工作者进行调查研究。调查内容围绕不同地区消化内科(脾胃病科)专科建设情况、胃癌前病变筛查技术及筛查能力、胃癌前病变专病管理等问题进行。结果:共收集有效问卷824份,来自全国的608家医疗机构共计786名被调查者参与了调研,参与者所在医疗机构中三级医院、二级医院、一级医院及其他医疗机构分别占比为48.8%(297家)、37.0%(225家)和14.1%(86家)。85.6%的医疗机构可进行普通电子胃镜检查,年平均检查量约0.6万人次,部分三级和二级医疗机构可开展放大内镜检查(50.6%)、色素内镜(47.6%)、窄带成像(43.6%)、蓝激光成像(25.4%)、智能电子分光内镜技术(26.3%)及共聚焦显微内镜检查(20.8%)。69.8%的医疗机构建有独立的病理科,80.0%的医疗机构胃镜病理标本具有规范的处理流程,57.9%的医疗机构病理科可进行免疫组织化学染色分析。51.7%的医疗机构具备肠化分型的条件,57.8%的医疗机构将慢性萎缩性胃炎(CAG)列为科室优势病种,54.2%的医疗机构具备规范的CAG、胃癌前病变管理流程,69.1%的被调查医疗机构具备胃镜、病理、辅助检查信息一体化管理的条件。结论:目前我国消化内镜诊疗水平总体发展迅速,但各地区不同级别医疗机构资源分配不平衡、对胃癌前病变的筛查及诊疗能力差距较大。胃癌前病变专病管理工作具有潜在的数据库和硬件基础,发展规范成熟的专病管理模式对胃癌前相关病变的防治工作意义重大。

Objective:Study the screening and specialized disease management of gastric precancerous lesions in different regions and levels of medical institutions in China.Methods:The investigator conducted an online questionnaire survey on digestive specialists at different levels of medical institutions across the country from August 25,2020,to September 25,2020.The survey focuses on the construction of specialized departments in gastroenterology(spleen and stomach diseases) in different regions,screening techniques and capabilities for gastric precancerous lesions,and specialized disease management for gastric precancerous lesions.Results:A total of 824 valid questionnaires were collected,and a total of 786 personnel from 608 medical institutions across the country participated in the survey.Among the medical institutions where the participants were located,tertiary hospitals,secondary hospitals,primary hospitals,and other medical institutions accounted for 48.8%(297),37.0%(225),and 14.1%(86),respectively.85.6% of medical institutions can perform regular electronic gastroscopy examinations,with an average annual examination volume of about 6000 people.Some tertiary and secondary medical institutions can perform magnifying endoscopy examinations(50.6%),pigment endoscopy(47.6%),NBI(43.6%),BLI(25.4%),MBI/FICE(26.3%),and CLE examinations(20.8%).69.8% of medical institutions have independent pathology departments,80.0% of medical institutions have standardized processing procedures for gastroscopy pathological specimens,and 57.9% of medical institutions have pathology departments that can perform immunohistochemical staining analysis.51.7% of medical institutions have the conditions for intestinal metaplasia classification,57.8% of medical institutions list CAG as a dominant disease in their departments,54.2% of medical institutions have standardized management processes for CAG and gastric precancerous lesions,and 69.1% of surveyed medical institutions have the conditions for integrated management of gastroscopy,pathology,and auxiliary examination information.Conclusion:At present,the diagnosis and treatment level of digestive endoscopy in China has developed rapidly in general,but the resource allocation of medical institutions at different levels in different regions is uneven,and the screening diagnosis and treatment ability of precancerous lesions of gastric cancer is far from enough.The management of gastric precancerous lesions has a potential database and hardware foundation.The development of standardized and mature disease management modes is of great significance for the prevention and treatment of gastric precancerous lesions.