[A survey on the current development of thoracic surgery in tertiary hospitals of China].

Objective: To study the current development of thoracic surgery in China. Methods: Chinese Society for Thoracic and Cardiovascular Surgery and Chinese Association for Thoracic Surgeons jointly conducted a network survey to directors of thoracic surgery departments in the tertiary hospitals in China from November to December 2018. The contents of the survey included the basic information of the hospital and the status of thoracic surgery department in the hospital. Rank sum test was used to compare the data between different regional hospitals Results: A total of 636 tertiary hospitals participated in the survey. The total number of beds for thoracic surgery departments was 30 646, with M(Q(R)) of 40(20) (range: 3 to 393) for each hospital. The total number of thoracic surgeons was 6 747, with M(Q(R)) of 9(6) (range: 1 to 75) in each hospital. In 2015, a total of 312 425 operations were performed in the 636 hospitals, with M(Q(R)) of 268(484.5) (range: 4 to 8 320) for each hospital. The total number of lung cancer surgeries was 146 601 in 2015, with M(Q(R)) of 100(216) (range: 0 to 6 911) operations in each hospital. The total number of esophageal cancer operations was 67 076, with M(Q(R)) of 40(95) (range: 0 to 1 550) in each hospital. Minimal invasive thoracic surgery was performed in 94.3% (601/636) of the hospitals, with 86.6% (551/636) of hospitals carried out video-assisted thoracoscopic (VATS) lobectomy. Among the hospitals performing VATS lobectomy, 89.3% (492/551) of them started to perform the technique after 2006, and 93.1% (513/551) of them do single-direction thoracoscopic lobectomy. A total of 403 640 VATS lobectomies had been performed until 2015, including 163 682 cases of single-direction thoracoscopic lobectomy. In 2015, 73.74% (108 116/146 601) lung cancer operations and 37.44% (25 110/67 076) of esophageal cancer resections were performed by minimally invasive technique. The development level of hospitals among eastern, middle and Western China was different significantly on number of doctors, number of total operations, number of lung cancer surgeries, proportion of minimally invasive lung cancer surgery, number of esophageal cancer surgeries, and proportion of minimally invasive esophageal cancer surgery (χ(2)∶7.65 to 60.8, all P<0.05). Conclusions: The discipline of thoracic surgery, especially the minimally invasive thoracic surgery in China is now experiencing a rapid development. The proportion of minimally invasive lung cancer surgery is higher than that of in the developed countries. However, unbalanced development among different regions is still a great challenge in China.目的： 了解我国胸外科学科临床的发展现状。 方法： 2016年11—12月，中华医学会胸心血管外科分会及中国医师协会胸外科医师分会利用网络调查方式联合开展胸外科学科临床发展现状的调查。调查对象为全国三级医院胸外科主任。调查项目包括医院基本情况、胸外科的基本情况、微创胸外科手术开展情况。不同地区医院的比较采用秩和检验。 结果： 636家有胸外科业务的三级医院接受了本次调查。胸外科床位数3～393张[M(Q(R))：40(20)张]，总数30 646张；胸外科医师1～75人[9(6)人]，总数6 747人。2015年全身麻醉胸外手术4～8 320例[268(484.5)例]，总数312 425例；肺癌手术0～6 911例[100(216)例]，总数146 601例；食管癌手术0～1 550例[40(95)例]，总数67 076例。94.3%(601/636)的医院开展了胸腔镜手术，86.6%(551/636)的医院能够开展胸腔镜肺叶切除术；已开展胸腔镜肺叶切除的医院中，89.3%(492/551)的医院在2006年之后开始开展胸腔镜肺叶切除，93.1%(513/551)的医院开展单向式胸腔镜肺叶切除术。截至2015年，累计开展胸腔镜解剖性肺切除手术403 640例，其中单向式胸腔镜肺叶切除术163 682例。2015年全国胸外科采用胸腔镜的肺癌手术比例为73.74%(108 116/146 601)，食管癌的微创手术比例为37.44%(25 110/67 076)。东部、中部、西部地区医院的床位数、胸外科医师数量、年全身麻醉胸外手术量、年肺癌手术量、肺癌手术腔镜比例、年食管癌手术量、食管癌手术腔镜比例差异均有统计学意义(χ(2)为7.65～60.8，P均<0.05)。 结论： 我国胸外科整体发展较好，尤其是微创技术发展迅速，微创肺手术比例高于发达国家水平，但存在着地区间发展不平衡等问题。.