农村卫生：在一个孤立的农村神经外科单位能做什么和不能做什么

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2025-06-19 DOI:10.1016/j.neuchi.2025.101695

Lorenzo Mongardi , Etienne Lefevre , Stéphane Litrico , Marie-Charlotte Hesler , Ugo Torrente , Guillaume Coll , Léo Nanty , Jean-Rodolphe Vignes , Stephane Fuentes , Paul Roblot

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引用次数: 0

摘要

尽管高收入国家的三级神经外科缺乏先进的技术基础设施，但该研究的目的是确定哪些神经外科手术可以在孤立的农村神经外科单位安全有效地进行。方法：作者借鉴了他们在偏远的太平洋群岛建立一线神经外科单位的经验，这是在没有重大技术投资的情况下完成的。纳入了从2023年12月1日至2025年2月1日在新喀里多尼亚努姆萨玛地区医院神经外科手术的所有患者。主要结局指标为复合终点，包括术后3个月内的死亡率、术后3个月内的再手术、术后并发症引起的继发转移。结果134例患者共行155例手术。其中颅脑手术129例，脊髓手术5例。155例手术中，急诊手术107例（69.0%），计划手术48例（31.0%）。急诊手术最常见的指征是外伤性脑损伤（TBI）（47/107-43.9%）、脑脊液紊乱（24/107-22.4%）和自发性颅脑感染（13/107-12.1%）。计划手术中肿瘤切除31例（31/48 ~ 64.5%），异源颅骨成形术12例（12/48 ~ 25.0%）。93.8%的计划手术术后病程良好。107例急诊手术中有14例（14/107−13.1%）需要再次手术（术后感染4例，术后血肿2例，术后颅内高压1例，慢性硬膜下血肿复发2例，伤口感染5例）。结论我们的经验证实，即使有可能将高度复杂的病例转移到配备先进手术设备的中心，大多数神经外科病例可以在没有所有技术工具的情况下安全地进行现场处理。在偏远地区，不可能在四小时内转移到第三医疗中心，这样一个单位的存在不仅是安全的，而且对提高医疗服务质量至关重要。由于有可能处理现场术后并发症，在农村单位有住院神经外科医生也有助于减少二次转移的需要。

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Rural Health: What can and cannot be done in an isolated rural neurosurgical unit

Objective

The aim of the study is to ascertain which neurosurgical procedures can be safely and effectively performed in an isolated rural neurosurgical unit, despite the lack of advanced technological infrastructure available in tertiary neurosurgical departments in high-income countries.

Methods

The authors draw upon their experience of establishing a first-line neurosurgical unit in a remote Pacific archipelago, which was accomplished without significant technological investments. All the patients operated in the neurosurgical unit of the Territorial Hospital of Nouméa, New Caledonia, from December 1, 2023, to February 1, 2025, were included. The primary outcome measure was a composite endpoint, including the mortality within three months post-surgery, reoperation within three months post-surgery, secondary transfer due to postoperative complications.

Results

134 patients underwent 155 procedures. Among them, 129 patients underwent cranial surgery while 5 patients underwent spinal cord surgery. Among the 155 procedures, 107 (69.0%) were emergency surgeries, 48 (31.0%), were planned surgeries. The most frequent indications for emergency surgery were traumatic brain injuries (TBI) (47/107–43.9%), CSF disorders (24/107–22.4%), and spontaneous cranial infections (13/107–12.1%). Among the planned surgeries, 31 were tumor resection (31/48–64.5 %) while 12 were heterologous cranioplasties (12/48−25.0%). The postoperative course was favorable for 93.8% of planned surgeries. Among the 107 emergency surgeries, 14 (14/107−13.1%) required reoperation (4 postoperative infections, 2 postoperative hematomas, 1 postoperative intracranial hypertension, 2 recurrences of chronic subdural hematomas and 5 wound infections).

Conclusion

Our experience confirmed that the majority of neurosurgical cases can be safely manage on site without all the technological tools even if the possibility to transfer high complexity cases in a center equipped with advanced surgical devices still plays a fundamental role.

In isolated regions where transfer to a tertiary center within four hours is impossible, the presence of such a unit is not only safe but essential to improve the quality of healthcare services.

Having a resident neurosurgeon in a rural unit can also be beneficial in reducing the need for secondary transfers due to the possibility to manage on-site post operative complication.

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.