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目的评价近10年来上海市推行《中国常见恶性肿瘤诊治规范》(胃癌)的效果,为卫生行政部门进一步促进该项工作提供科学决策依据。方法采用连续跟踪、随机抽样的方法,检查二、三级医院的胃癌出院病例,以《规范》为标准,并请胃癌专家评审。结果上海市胃癌总体规范治疗率为29.93%,基本规范治疗率为45.77%,两率合计为75.70%,比1994年提高了25.7个百分点;不规范治疗率比1994年下降了4.5个百分点;市级、区级医院规范治疗率高于县级医院;市级医院基本规范治疗率高,比较稳定。手术治疗病例的规范治疗率较高(33.49%);在明确分期的病例中占34.51%。结论上海市通过推行《诊治规范》,使胃癌规范治疗率有所上升。应采取针对性措施,加大培训和质控力度,创造支持性环境,探索有机的综合治疗工作模式,制定转诊政策,进一步提高恶性肿瘤的诊治水平,以提高治愈率、生存率和生活质量。
Objective To evaluate the effect of Shanghai’s implementation of the “Code of Practice for the Diagnosis and Treatment of Common Malignancies in China” (gastric cancer) in the past 10 years and provide the scientific administrative decision-making basis for the health administrative departments to further promote this work. Methods The methods of continuous follow-up and random sampling were used to examine the cases of gastric cancer discharged from secondary and tertiary hospitals. Results The overall standard treatment rate of gastric cancer in Shanghai was 29.93%, the basic standard treatment rate was 45.77%, the total of two rates was 75.70%, an increase of 25.7% over 1994; the non-standard treatment rate was 4.5% lower than that of 1994; Level, district-level hospital standard treatment rate higher than the county hospital; municipal hospital basic standard treatment rate is relatively stable. The standard treatment rate of surgical treatment of cases higher (33.49%); in clear staging cases accounted for 34.51%. Conclusion Shanghai City, through the implementation of “diagnosis and treatment norms”, so that the standard treatment of gastric cancer increased. Targeted measures should be taken to increase the training and quality control, create a supportive environment, explore organic integrated treatment work patterns, formulate referral policies and further improve the diagnosis and treatment of malignant tumors so as to improve the cure rate, survival rate and quality of life .