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[目的]基于单病种全程管理的理念研发鼻咽癌新型临床路径,以促进鼻咽癌的规范化诊断与治疗。[方法]以本中心鼻咽癌诊疗规范为基础设计诊疗全程的临床路径,将符合入径病例纳入路径管理,预期目标入路径率(适合入路径者/符合入路径者)≥50%;完成路径率(完成路径者/入路径者)≥70%;非预见内的变异率(非预见内的变异/入路径者)<10%。[结果 ]自2015年1月1日至12月31日,共收治39例新确诊鼻咽癌患者,36例符合入路径标准,100%(36/36)进入路径。完成路径率97.2%(35/36),变异率8.3%(3/36)。诊断与分期阶段、诱导化疗阶段(共3周期)、单纯放疗、同期放化疗阶段平均住院日分别为0.8、8.2、0、18.7d。单纯放疗产生的平均费用为(83 564±77)元,同期放化疗为(109 316±15 050)元,诱导化疗+同期放化疗的治疗模式产生的平均费用为(118 744±11 341)元。[结论]较高的入路径率、较高的完成路径率、较低的变异率体现了基于单病种全程管理的鼻咽癌新型临床路径有效可行,值得进一步推广应用。
[Objective] To develop a new clinical pathway of nasopharyngeal carcinoma based on the idea of whole disease management in order to promote the standardized diagnosis and treatment of nasopharyngeal carcinoma. [Methods] Based on the diagnosis and treatment of nasopharyngeal carcinoma in our center, the clinical pathways of the whole course of diagnosis and treatment will be met, which will be in accordance with the pathological management of pathological cases, and the expected path-to-path rate (suitable for pathoners / Pathway rate (those who complete the pathway / enter the pathway) ≥70%; within the unforeseen rate of mutation (within the unforeseen variance / pathway) <10%. [Results] From January 1, 2015 to December 31, 2015, 39 newly diagnosed nasopharyngeal carcinoma patients were enrolled. Thirty-six patients were eligible for pathology and 100% (36/36) for pathways. The completion rate was 97.2% (35/36) and the variation rate was 8.3% (3/36). Diagnosis and staging, induction chemotherapy stage (a total of 3 cycles), radiotherapy alone, the same period of radiotherapy and chemotherapy stage average length of stay were 0.8,8.2,0,18.7 d. The average cost of radiotherapy alone was (83 564 ± 77) yuan, compared with that of radiotherapy (109 316 ± 15 050) yuan for the same period. The average cost of radiotherapy and chemotherapy plus radiotherapy was (118 744 ± 11 341) yuan . [Conclusion] The higher path entry rate, higher completion path rate, and lower mutation rate reflect the new clinical pathway of nasopharyngeal carcinoma based on the single pathological management, which is worthy of further popularization and application.