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自从引入腹腔镜手术,普遍认为应用腹腔镜进行附件手术会取代开腹手术。然而事实证明,虽然腹腔镜手术开展了20多年,开腹附件手术仍未被淘汰。这份来自澳大利亚各州及地区关于附件手术病人的资料显示了在澳大利亚应用腹腔镜进行附件手术的变化趋势。同时还有一份来自悉尼利物浦医院病人的资料同样也说明了在附件手术中决定选择何种手术方式的影响因素。我们的研究认为,在所有附件手术中,应用腹腔镜进行手术已经增加到90%,然而大概还有10%的病人需要开腹手术。全国范围内附件手术在手术方式选择上的变化趋势受政府医疗保险政策变化的影响。利物浦医院的当地资料显示,不同个体在手术方式选择上的变化趋势与澳大利亚全国范围内附件手术方式变化趋势不同,是由于管理人员和资金的改变引起的。从病人利益角度考虑,一项对妇科医师问卷调查显示,下述因素是导致医师选择开腹手术的重要原因:术前怀疑肿瘤是恶性的;医生缺少腹腔镜技术的培训;急诊状况下。术前应用敏感性高和特异性好的肿瘤标志物改善附件恶性肿瘤术前诊断的准确性有利于更多病人进入腔镜组而不是开腹组,同时医师经过良好的训练和提高手术技术也可以在不久的将来促进腹腔镜手术的发展。
Since the introduction of laparoscopic surgery, it is generally accepted that laparoscopic accessory surgery will replace laparotomy. However, it turns out that laparoscopic surgery has not been eliminated despite more than 20 years of laparoscopic surgery. The data from the Australian states and regions about surgical patients with attachments show the trend of applying laparoscopic accessory surgery in Australia. At the same time there is also a source of information from patients at Liverpool Hospital in Sydney also illustrates the factors that determine the surgical approach in the annex surgery. Our study concluded that surgery on laparoscopic surgery has increased to 90% in all adjunctive surgery, yet about 10% of patients require laparotomy. Changes in the selection of surgical procedures for attachment surgery across the country are subject to changes in government health insurance policies. Local data from Liverpool Hospitals show that trends in the choice of surgical modalities vary with trends in the way surgical procedures are performed throughout Australia, due to changes in management and funding. From a patient’s perspective, a questionnaire survey of gynecologists found that the following factors were the main reasons leading to physicians opting for laparotomy: preoperative suspicion of malignancy of the tumor; lack of training in laparoscopic surgery by doctors; and emergency treatment. Preoperative application of high sensitivity and specificity of tumor markers to improve the accuracy of preoperative diagnosis of accessory malignant tumor is conducive to more patients into the endoscopic group rather than open group, while physicians through good training and improve surgical techniques Can promote the development of laparoscopic surgery in the near future.