探讨多学科随访模式在减重代谢外科质量控制中的实证研究。

回顾性分析2016年1月至2016年12月在南京医科大学第一附属医院减重代谢外科接受手术的110例肥胖症患者的临床资料。2016年1月至2016年6月入院的患者由外科医生主导随访，作为传统减重管理组（对照组）；2016年7月至2016年12月入院的患者，其术后随访由多学科团队共同完成，作为多学科随访管理组（研究组）。其中研究组57例，男16例，女41例，年龄（46.1±10.9）岁；对照组53例，男14例，女39例，年龄（42.2±8.3）岁。多学科随访管理组由减重外科医生、减重管理师、内分泌科医生、营养科医生组成；传统减重管理随访组由外科医生和减重管理师构成。比较两组患者的术后随访率、医疗服务满意率和术后营养并发症的发生率、术后胃肠道并发症的发生率、多余体重减少率。

研究组术后1年随访率为82.5%，明显高于对照组（χ2=14.907，P<0.05）；研究组患者的多余体重减少率为（83.1±16.1）%，明显高于对照组（t=3.959，P<0.05）；研究组患者对手术效果的满意率为93.0%（53/57），明显高于对照组的73.6%（39/53）（χ2=4.410，P<0.05）；研究组患者营养并发症发生率为5.3%（3/57），明显低于对照组的22.6%（12/53）（χ2=4.961，P<0.05）。

多学科随访模式能适应代谢外科多学科综合治疗的需要，在提高患者随访率、降低术后并发症的发生、增加患者术后多余体重减少率、提高患者满意度方面，较传统减重管理模式有明显优势。

To explore the empirical study on multidisciplinary follow-up model in quality control of bariatric and metabolic surgery.

The clinical data of 110 patients, who underwent surgery in the department of bariatric and metabolic surgery of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2016, were retrospectively analyzed. In the first half year, the follow-up was mainly conducted by surgeons. In the second half year, a multidisciplinary follow-up group was established. These patients were divided into multidisciplinary follow-up management group (research group) and traditional management group (control group). There were 57 cases in the research group with 16 males and 41 females, and the mean age was (46.1±10.9) years. There were 53 cases in the control group with 14 males and 39 females, and the mean age was (42.2±8.3) years. The multidisciplinary follow-up mode includes bariatric surgeons, case managers, endocrinologist and dietitian; while the traditional management follow-up group only includes bariatric surgeons and case managers. Postoperative follow-up rate, patients’ satisfaction to medical services, postoperative nutritional complications, postoperative gastrointestinal complications and excess weight loss between these two groups were compared.

The 1-year follow-up rate in the research group was 82.5%, which was significantly higher than the control group (P<0.05); the rate of excess weight loss in the research group was (83.1+16.1)%, which was significantly higher than the control group; the rate of patients' satisfaction to surgical outcomes was 93% (53/57) in the research group, which was significantly higher than the control group (73.6%, 39/53, χ2=4.410, P<0.05); the rate of nutritional complications in the research group was 5.3% (3/57), which was significantly lower than the control group (22.6%, 12/53, χ2=4.961, P<0.05).

Multidisciplinary follow-up model can adapt to the needs of multidisciplinary treatment in metabolic surgery, improve the follow-up rate, increase the rate of postoperative excess weight loss and patients’ satisfaction, and decrease postoperative complication rate. Thus, it has obvious advantages compared with the traditional management model.