新型冠状病毒肺炎疫情期间乳腺外科运行情况分析
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齐晓伟, Email: qxw9908@foxmail.com

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Analysis of operations of breast surgery during the COVID-19 epidemic
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    摘要:

    背景与目的:尽管目前国内新型冠状病毒肺炎(COVID-19)疫情得到了有效的控制,但国外病例仍在持续增加,防控形势依然严峻。本研究以陆军军医大学第一附属医院乳腺外科为例,分析总结新型冠状病毒肺炎疫情期间综合性三甲医院乳腺外科运行情况,为疫情期间及后疫情时期安全、高效地开展乳腺外科工作提供有效参考和经验做法。
    方法:选取自2020年1月31日—2020年2月20日COVID-19流行期间陆军军医大学第一附属医院乳腺甲状腺外科收治的37例乳腺癌患者,对其临床特征、防护手段及治疗效果等病例资料进行回顾性分析。对患者的入院和术前准备、术中防护、术后康复等关键环节,以及医护人员自我防护及心理疏导进行方法总结。对专科治疗及疫情防控的效果进行随访研究。分析在后疫情时期如何提升对潜在传染病风险的认知,结合乳腺外科的诊治特点,从手术指征把握、气溶胶管理和诊室防护等多方面加强疫情防控和职业防护工作。
    结果:37例乳腺癌患者经排除COVID-19风险后均接受手术治疗,平均手术时间为(152.23±46.19)min,平均术中出血量为(85.23±23.47)mL,无术中输血病例。在37例乳腺癌患者中,有19例患者接受术前6~8周期新辅助治疗,其中7例术后证实为病理学完全缓解。术后2例出现持续发热,经过隔离、监测体温及对症支持治疗后恢复正常,新型冠状病毒核酸检测排除COVID-19感染可能。经跟踪随访,患者及陪护人员均无发热、咳嗽、乏力等COVID-19疑似表现,相关医护人员同样未出现疑似病例,总体防控效果较好。
    结论:在COVID-19疫情流行期间,在科学防控、竭力避免医患双方感染COVID-19的前提下,可结合当地疫情情况全力为乳腺癌患者提供有效治疗。应继续遵从“科学决策、人文服务”的精神,严格遵循上级下发的各类防控指南和管理规范,并依据实际完成乳腺癌患者的院前排查、术前准备、术中防护、术后康复等必要环节。严格在患者入院前及围手术期各环节遵循疫情防护规范、协调好疫情防控与专科诊治的关系,有利于最大限度地确保乳腺外科手术安全地完成,守护患者及医务人员的健康。

    Abstract:

    Background and Aims: Despite that the epidemic of novel coronavirus pneumonia (COVID-19) has been under effective control in China, the number of cases outside our country is continuously growing. So, the prevention and control situation is still grim. This study, taking the Department of Breast Surgery in the First Affiliated Hospital of Army Medical University as an example, was designed to analyze and summarize the operations of breast surgery in a comprehensive tertiary hospital during the epidemic, so as to provide effective reference and experiential practice for conducting safe and efficient breast surgery work during epidemic and post-epidemic periods. 
    Methods: Thirty-seven patients with breast cancer admitted in the Department of Breast Thyroid Surgery of the First Affiliated Hospital of Army Medical University during the COVID-19 epidemic period of January 31, 2020 to February 20, 2020 were selected. The data of the patients including the clinical characteristics, protective measures and treatment effects were retrospectively analyzed. The main points of methods for patients' admission to hospital, preoperative preparation, intraoperative protection and postoperative recovery, as well as the self-protection and psychological counseling of the medical staff were summarized. The effects of specialized treatment and epidemic prevention and control were identified by follow up. The details for how to improve the cognition of potential risk for infectious diseases, and how to strengthen the prevention and control of epidemic disease and occupational protection during the post-epidemic period were analyzed from the aspects of surgical indications, aerosol management and clinic protection in combination with the diagnosis and treatment characteristics of breast surgery. 
    Results: Thirty-seven patients received surgical treatment after the exclusion of the risk of COVID-19. The mean operative time was (152.23±46.19) min, the average intraoperative blood loss was (85.23±23.47) mL, and no intraoperative blood transfusion was required in any of the patients. Among the 37 breast cancer patients, 19 cases underwent 6 to 8 cycles of preoperative neoadjuvant therapy, of whom, complete pathological remission was obtained in 7 cases after surgery. Prolonged fever occurred in 2 patients after operation, which returned to normal after isolation, body temperature monitoring and symptomatic treatment, and COVID-19 was excluded by nucleic acid testing for SARS?CoV?2. After follow-up, no suspected COVID-19 symptoms such as fever, cough and fatigue were noted in any of the patients or their accompanying relatives, and also no suspected cases were observed among the relevant medical staff. 
    Conclusion: During the epidemic period, on the premise of scientific prevention and control, and full avoidance of COVID-19 infection in both doctors and patients, aggressive treatment can be provided to breast cancer patients according to the local epidemic situation. The principles of "scientific decision-making, and humanistic service" should be continuously followed, and the various prevention and control guidelines and management norms issued by superiors should be strictly obeyed, and the necessary elements such as prehospital screening, preoperative preparation, intraoperative protection and postoperative recovery of the breast cancer patients should be completed according to the actual situation. Rigorous compliance with the protection measures against epidemic in all aspects of the pre-admission and perioperative period of the patients, and coordinated relations of the epidemic prevention and control with the specialized treatment, may maximally ensure the safe completion of breast surgery and protect the health of the patients and medical personnel. 

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刘静, 钟玲, 谭璇妮, 张毅, 姜军, 齐晓伟,.新型冠状病毒肺炎疫情期间乳腺外科运行情况分析[J].中国普通外科杂志,2020,29(5):543-548.
DOI:10.7659/j. issn.1005-6947.2020.05.004

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  • 收稿日期:2020-03-18
  • 最后修改日期:2020-04-20
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  • 在线发布日期: 2020-05-25