新疆北部地区胆囊息肉治疗现状的相关研究

发布时间：2018-05-02 09:57

  本文选题：北疆地区 + 胆囊息肉　； 参考：《石河子大学》2015年硕士论文

【摘要】：目的:通过分析研究北疆地区14所医院自2011年1月到2013年12月收治的胆囊息肉患者的相关病例资料,了解北疆地区胆囊息肉的治疗现状及相关影响因素,为探寻可能存在的“不合理医疗干预”成因奠定基础。方法:采用统一制定的《胆囊息肉干预情况调查表》,完整全面的收集北疆地区各州县市14所医院自2011年1月到2013年12月收治的胆囊息肉患者病例资料。对北疆地区胆囊息肉人口学分布、生物学分布及干预情况进行回顾性分析研究。利用统一制定的《胆囊息肉认知水平调查问卷》对收治胆囊息肉科室医生进行问卷调查,了解北疆地区相关科室医生对胆囊息肉的认知水平。结果:1、14家医院共收集临床病例资料1483份,二级医院806例(54.35%),三级医院677例(45.65%);手术病例1177例(79.37%),非手术病例306例(20.63%);男性患者853例(57.52%),女性患者630例(42.48%);汉族1146例(77.3%),少数民族337例(22.7%),其中回族86例,维吾尔族105例,哈族97例,蒙古族43例,锡伯族6例。年龄14-83岁,平均年龄43.17岁;2、通过B超检出1316例(88.74%),通过CT检出167例(11.26%);常规体检发现986例(66.49%),因出现胆囊疾病相关临床症状就诊发现278例(18.75%),因其他疾病就诊发现219例(14.76%);胆囊息肉大小1cm者665例,1-1.5cm者631例,1.5cm者187例。3、开腹胆囊切除术93例、腹腔镜下胆囊切除术833例、微创保胆取息肉术251例;药物治疗87例;随访观察219例;4、胆固醇性息肉973例(82.67%),炎性息肉117例(9.94%),胆囊腺肌增生症50例(4.25%),腺瘤性息肉37例(3.14%);5、≥60岁组、离退休组、没上过学组和小学组患者较同组其他胆囊息肉患者手术率低,差异具有统计学意义;无保险组和新农合组较职工医保组和居民医保组胆囊息肉患者手术率低,差异具有统计学意义;少数民族较汉族胆囊息肉患者手术率高,差异具有统计学意义;不同性别手术率比较差异无统计学意义;6、胆囊息肉大小1cm组手术率较其他两组手术率低,差异具有统计学意义;胆囊息肉大小1-1.5cm组与1.5cm组手术率比较差异不具有统计学意义;不同干预方式中有无临床症状的比例不同,差异具有统计学意义;7、二级医院中不符合手术指征行手术治疗及符合手术指征未行手术治疗的病例数较三级医院多,差异具有统计学意义(P0.05);8、三级医院医护人员对胆囊息肉相关知识认知程度较二级医院医护人员认知程度高,差异具有统计学意义(P0.05)。结论:1、在北疆地区胆囊息肉的治疗中大部分遵循手术指征行手术治疗,但仍存在一定的过度干预问题或干预不足问题,二级医院较三级医院情况严重。2、目前腹腔镜下胆囊切除术是胆囊息肉手术的主要术式,胆固醇性息肉是常见的病理类型。3、年龄、民族、职业、受教育程度、有无医疗保险对胆囊息肉患者是否选择行手术治疗有一定影响,性别对其无影响。4、三级医院医护人员对胆囊息肉认知水平较二级医院医护人员高。
[Abstract]:Objective: to study the clinical data of patients with gallbladder polyps treated in 14 hospitals in Northern Xinjiang from January 2011 to December 2013, and to understand the current situation of treatment of gallbladder polyps in Northern Xinjiang and the related influencing factors. In order to explore the possible causes of "unreasonable medical intervention" lay the foundation. Methods: the data of cases of gallbladder polyps from January 2011 to December 2013 in 14 hospitals in Northern Xinjiang were collected by using the questionnaire on the intervention of gallbladder polyps. The demographic distribution, biological distribution and intervention of gallbladder polyps in northern Xinjiang were analyzed retrospectively. In order to understand the cognition level of polyps of gallbladder in Northern Xinjiang, the questionnaire of cognition level of gallbladder polyps was made by using the questionnaire of cognition level of gallbladder polyps, which was conducted by doctors in department of gallbladder polyps. Results 1483 clinical cases were collected in 14 hospitals. There were 806 cases in the second class hospital, 677 cases in the third class hospital, 79.37 cases in the operation cases, 306 cases in the non-operative cases, 57.52 cases in the male patients, 630 cases in the female patients, 1146 cases in the Han nationality, 77.33 cases in the Han nationality, 337 cases in the ethnic minorities, 86 cases in the Hui nationality, 105 cases in the Uygur nationality, and 97 cases in the Kazakh nationality. There were 43 Mongolian and 6 Xibo. Aged 14-83, The mean age was 43.17 years old, 1316 cases were detected by B-mode ultrasound, 167 cases were diagnosed by CT, 66.49 cases were diagnosed by routine physical examination, 278 cases were diagnosed with clinical symptoms related to gallbladder diseases, 219 cases with other diseases, 219 cases with large gallbladder polyps. There were 665 cases with small 1cm (1-1.5 cm), 631 cases with 1.5 cm (187 cases. 3), 93 cases with open cholecystectomy, 93 cases with cholecystectomy. Laparoscopic cholecystectomy was performed in 833 cases, minimally invasive cholecystectomy in 251 cases, drug therapy in 87 cases, followed up observation in 219 cases (4 cases), 973 cases of cholesterol polyps (92.67), 117 cases of inflammatory polyps (P < 9.94), 50 cases of gallbladder adenomatosis (n = 50), 37 cases of adenomatous polyps (n = 37) and 3.145 cases (鈮，

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