亚洲排名第1的癌症专科医院，凭什么这么牛?
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="http://mmbiz.qpic.cn/mmbiz_gif/tnLS7cAueJ5DkaJwyAmf4Pygw14RH8AOBnzQNdg0eZM0hwNKL14vHKjHRnM9H3ajw1t10nSsJAwvm4gibpkWSaA/0?tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></p><strong style="color: blue;">导读</strong>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">做为</span>引领亚洲癌症诊疗水平的医院，我<span style="color: black;">始终</span>怀着<span style="color: black;">极重</span>的好奇心——医院规模不大，却<span style="color: black;">最后</span>发展成亚洲最先进的癌症诊疗中心。这，是<span style="color: black;">怎么样</span>做到的？ </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">全文 </span><span style="color: black;">2246</span><span style="color: black;"> 字 <span style="color: black;">意见</span>阅读时间</span> <span style="color: black;">10</span><span style="color: black;">分钟</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJbckqcibicNvVKjB2OCjd5cBtGquf3TeUjy4ToCY9F9j1r9nJSTVtgZTZA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">自从北大深圳医院与东京癌研有明医院<span style="color: black;">创立</span>友好关系<span style="color: black;">败兴</span>，<span style="color: black;">已然</span>多次派出医护人员到东京学习。经过层层选拔和考核，我有幸<span style="color: black;">作为</span>了本批学员中的一员，2016年8月初，<span style="color: black;">起始</span>了为期90天的进修学习。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">做为</span>引领亚洲癌症诊疗水平的医院，我<span style="color: black;">始终</span>怀着<span style="color: black;">极重</span>的好奇心——医院规模不大，却<span style="color: black;">最后</span>发展成亚洲最先进的癌症诊疗中心。这，是<span style="color: black;">怎么样</span>做到的？</span></p><span style="color: black;"><strong style="color: blue;">医院初印象</strong></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参观医院的途中，<span style="color: black;">首要</span>看到的是门诊大厅，明亮、整洁。候诊的<span style="color: black;">病人</span>不少，但非常安静，<span style="color: black;">没</span>论是工作人员还是<span style="color: black;">病人</span>，都会刻意压低声线，低声<span style="color: black;">交流</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJbygetJ74432f1nKbXZXDDQKyfP69CGEcib1S8u2tVcAZibUtsfVQRh8Dg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/tnLS7cAueJ62OMPicmTNibjDs1pibqOuGKrt8uxbGJnhaTRSRibCIsYq4jXd8xodacnCStzqF5UWtibQTwhibEAhgWlQ/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> </span></strong>有明医院门诊大厅</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">日本就诊制度：预约+转诊</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJbqiaNlyMueoSrIrXHXIq1qvZRmACZlEpPHDFwg1NA9A6c1pH2q6YzneA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/tnLS7cAueJ62OMPicmTNibjDs1pibqOuGKrt8uxbGJnhaTRSRibCIsYq4jXd8xodacnCStzqF5UWtibQTwhibEAhgWlQ/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> </span></strong>有明医院内景</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">据介绍，日本<span style="color: black;">病人</span>就诊，采取的是预约制及转诊制，即：<span style="color: black;">病人</span><span style="color: black;">患病</span>了，先到社区医院就诊，<span style="color: black;">必要</span>取得基层医院转诊证明，<span style="color: black;">才可</span>到大医院治疗。<span style="color: black;">倘若</span>你信<span style="color: black;">不外</span>小医院而直接到大医院看病，对不起，保险<span style="color: black;">机构</span>不负责承担<span style="color: black;">昂贵</span>的医疗<span style="color: black;">花费</span>。<span style="color: black;">因此</span>，几乎所有来院的<span style="color: black;">病人</span>，都<span style="color: black;">已然</span>预约好转院的时间及就诊科室（土豪除外），不存在国内医院门诊大排长龙、人满为患的<span style="color: black;">状况</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJbr5Jjt5rjibrhPQAwp8GQSib6ykgoPfEnTvYTKaKj0SnqmI20ib6dszG3g/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/tnLS7cAueJ62OMPicmTNibjDs1pibqOuGKrt8uxbGJnhaTRSRibCIsYq4jXd8xodacnCStzqF5UWtibQTwhibEAhgWlQ/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></strong></span><span style="color: black;"> <span style="color: black;">病人</span>待诊区 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJbOQWD7FiaNVVZhAGoGibiap6MJ2pNdWaqOuCaB00GFf3YSquCMxGoVJNWg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/tnLS7cAueJ62OMPicmTNibjDs1pibqOuGKrt8uxbGJnhaTRSRibCIsYq4jXd8xodacnCStzqF5UWtibQTwhibEAhgWlQ/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></span></strong><span style="color: black;">PHS设备</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">病人</span>来到医院后，完成登记手续，会领到一个类似手机的设备（PHS）。轮候到号时，PHS会发出蜂鸣及震动提示。<span style="color: black;">病人</span><span style="color: black;">能够</span>在医院范围内随意走动，<span style="color: black;">没</span>需在诊室区域干等。避免了大屏幕<span style="color: black;">表示</span>和电脑叫号，<span style="color: black;">守护</span>患者隐私的<span style="color: black;">同期</span>，<span style="color: black;">亦</span>减少了噪音。</span></p><span style="color: black;"><strong style="color: blue;">完善的制度</strong></span>病例讨论制度<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">每周<span style="color: black;">2、</span>周四，是科室的病例讨论时间。从早晨7点半到9点，上至院长、下到住院<span style="color: black;">大夫</span>都<span style="color: black;">必要</span>准时参加。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJb10YYXEx2EqUic1ad7ianaQibicgWgSMwTdFKT2Wryu7sHHZZtnGJ6NFXbw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/tnLS7cAueJ62OMPicmTNibjDs1pibqOuGKrt8uxbGJnhaTRSRibCIsYq4jXd8xodacnCStzqF5UWtibQTwhibEAhgWlQ/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> </span></strong></strong><span style="color: black;">病例讨论会</span> </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">讨论会简明而<span style="color: black;">有效</span>，住院<span style="color: black;">大夫</span><span style="color: black;">报告</span>病例时，制作幻灯片，一目了然。给我的感受是，住院<span style="color: black;">大夫</span>的<span style="color: black;">基本</span>知识功底扎实，对肿瘤的病理生理、影像学、消化内镜表现、病理特点等都了如指掌。每一条<span style="color: black;">关联</span>的血管、每一个可疑的淋巴结都能够识别并标示出来。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">更进一步，<span style="color: black;">针对</span><span style="color: black;">有些</span>存在<span style="color: black;">要紧</span>血管变异的案例，<span style="color: black;">她们</span>能够在术前CT阅片中提前<span style="color: black;">发掘</span>，并思考术中的应对预案，提出来由全科讨论<span style="color: black;">是不是</span><span style="color: black;">恰当</span>可行。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如此<span style="color: black;">要紧</span>的工作，<span style="color: black;">常常</span><span style="color: black;">必须</span>画图<span style="color: black;">才可</span>解释得清楚，于是在讨论会上，经常能看到<span style="color: black;">这般</span>的画面：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="http://mmbiz.qpic.cn/mmbiz_jpg/tnLS7cAueJ6T8ObJJRrEAzgIuCacVDJbB7ibpmVicfSgcP4pZ9InQX3OMJE1lxZt55SVY1LfyUMiclQicC3NR76ptw/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/tnLS7cAueJ62OMPicmTNibjDs1pibqOuGKrt8uxbGJnhaTRSRibCIsYq4jXd8xodacnCStzqF5UWtibQTwhibEAhgWlQ/640?tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> </span></strong></strong><span style="color: black;"><span style="color: black;">美丽</span>吧？反正我是被惊艳了。</span> </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">与住院<span style="color: black;">大夫</span>交流得知，从大学<span style="color: black;">起始</span>，<span style="color: black;">每日</span><span style="color: black;">夜晚</span>，<span style="color: black;">她们</span>都<span style="color: black;">必须</span>花一两个小时来练习画图。先是对着实物画，练习到最后，就能够看着CT片子，<span style="color: black;">按照</span>解剖关系，把血管还原成<span style="color: black;">这般</span>一幅幅的图像了。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">况且</span>据我观察，<span style="color: black;">她们</span>术前画的图，非常精确，跟手术<span style="color: black;">其中</span>所见几乎<span style="color: black;">无</span>差异！</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">感叹之余，不禁让我想起了鲁迅笔下的那个对学生严格要求的藤野先生。</span></p>手术室安全核对制度<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">以前看日剧，看到男神唐泽寿明站在主刀的位置上，庄严地宣布：“今天，<span style="color: black;">咱们</span>为这位名叫XXX的<span style="color: black;">病人</span>进行食道癌根治性切除手术，手术时间预计5小时20分，估计<span style="color: black;">流血</span>量50 ml……”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">我<span style="color: black;">始终</span>以为，<span style="color: black;">这般</span>的画面，是出于艺术渲染。现实中<span style="color: black;">这般</span>做，太<span style="color: black;">扮演</span>化。没想到，这原来是真的。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">每台手术，不管手术前的气氛多么<span style="color: black;">容易</span>愉悦，都<span style="color: black;">必要</span>履行<span style="color: black;">这般</span>一个程序：手术<span style="color: black;">起始</span>时，主刀<span style="color: black;">大夫</span>站在台上，严肃地宣布今天要做的是什么手术，手术预计所需时间，预计<span style="color: black;">流血</span>量，主刀<span style="color: black;">大夫</span>是谁，助手有<span style="color: black;">那些</span>人，<span style="color: black;">麻木</span>师、护士由谁来担当等等，<span style="color: black;">乃至</span><span style="color: black;">包含</span>来自中国的李<span style="color: black;">大夫</span>，<span style="color: black;">亦</span>在宣读范围之内。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">起初我觉得有点置身于日剧里的感觉，有点滑稽。后来我才明白，这种做法，一方面是术前核对沟通，<span style="color: black;">保证</span>医疗安全；另一方面提醒<span style="color: black;">大众</span>停止开玩笑，要<span style="color: black;">起始</span>严肃认真地工作了。</span></p><span style="color: black;"><strong style="color: blue;">规范化手术</strong></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">规范化手术是日本外科学的标志性成绩。而日本医护人员严谨的工作态度，是<span style="color: black;">保证</span>规范化手术能<span style="color: black;">保持</span>执行的<span style="color: black;">基本</span>。</span></p>严格<span style="color: black;">按照</span>指南规定<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在<span style="color: black;">这儿</span>，不管是<span style="color: black;">青年</span><span style="color: black;">大夫</span>还是国际知名的教授主刀，每一台手术，淋巴结清扫的范围，胃肠肿瘤切除的距离，血管裸化到哪个程度，术中<span style="color: black;">必须</span>离断<span style="color: black;">那些</span>血管……都<span style="color: black;">必要</span>严格<span style="color: black;">按照</span>指南规定。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">指南规定距离肿瘤5cm切断，那就<span style="color: black;">必要</span>是手术中用尺量出来的5cm，不<span style="color: black;">准许</span>诸如“肉眼判断切缘干净了，凭经验感觉差不多了”之类的措辞。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">所有的肿瘤病例，在术中<span style="color: black;">必要</span>进行切缘的快速病理<span style="color: black;">检测</span>，<span style="color: black;">保证</span>肿瘤<span style="color: black;">无</span>残留。胃癌手术时，术中<span style="color: black;">必要</span>胃镜<span style="color: black;">检测</span>，离断前确定肿瘤位置及切缘距离；吻合后，胃镜<span style="color: black;">检测</span>吻合口<span style="color: black;">是不是</span>通畅，<span style="color: black;">保证</span><span style="color: black;">无</span>吻合口<span style="color: black;">流血</span>及吻合口漏。缝合加固吻合口后，再次胃镜<span style="color: black;">检测</span>，<span style="color: black;">保证</span><span style="color: black;">无</span>误缝……</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">术中<span style="color: black;">必要</span><span style="color: black;">保存</span>录像或拍照，证明自己<span style="color: black;">根据</span>标准做了，下轮病例讨论会上，要拿出来给<span style="color: black;">大众</span>监督。</span></p>“强迫症”造就精彩手术<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">让我印象深刻的是<span style="color: black;">第1</span>天参观胃癌手术，主刀<span style="color: black;">大夫</span>对其中一针的缝合不甚满意（在我看来，<span style="color: black;">没</span>伤大雅），但日<span style="color: black;">自己</span>认为不符合<span style="color: black;">需求</span>，于是拆了重缝，反复进行了8次，才满意结束。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">我想，正是这种看起来有点“强迫症”的工作态度，造就了每一台精彩的手术。在有明医院，80后的<span style="color: black;">医生</span>都出色地完<span style="color: black;">成为了</span>Whipple（胰头十二指肠切除）手术。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">手术结束后，<span style="color: black;">一样</span>是繁琐的工作流程：病理标本的处置，向<span style="color: black;">病人</span>家属交代病情，医疗文书的书写，<span style="color: black;">研究</span>数据的录入分析……<span style="color: black;">这儿</span>大<span style="color: black;">都数</span><span style="color: black;">大夫</span>的工作时间，是从早上7点到<span style="color: black;">夜晚</span>11点，深夜的办公室里，听不到抱怨的声音，<span style="color: black;">亦</span><span style="color: black;">无</span>嬉笑吵闹，<span style="color: black;">每一个</span>人都在默默地<span style="color: black;">奋斗</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">每日</span><span style="color: black;">夜晚</span>回到宿舍，我都会想，日本比<span style="color: black;">咱们</span>进步，<span style="color: black;">原由</span>有<span style="color: black;">非常多</span>。但有一点，是<span style="color: black;">咱们</span>能做到的，那<span style="color: black;">便是</span>加倍<span style="color: black;">奋斗</span>，加倍地专注于自己的工作。<span style="color: black;">仅有</span><span style="color: black;">这般</span>，<span style="color: black;">才可</span>不被时代淘汰。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">整理自<span style="color: black;">北京大学深圳医院</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">作者：李灼非，北京大学深圳医院胃肠外科</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">—THE END—</strong></span></strong></span></p>
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