Lean ????????? ???????????????? ??????????????????????? ?? ???? ???? Transnasal esophagoscopy (TNE)

1
Lean????????? ??????????????????????????????????
????? ?? ???? ???? Transnasal esophagoscopy (TNE)

• ??.??????? ???????????
• ?????????? ?? ??????????

29-01-53
2
?????

• ??????????????? ?? ??????????? ?????? 50-60
  ???/?????
• ???????? ?? ??????????????????????????????????????
  ????? (second primary cancer) ???? ??? ?????????
  ?????????????? 14
  
• ????????????????????? ????? ?????????????
  
  (oral cavity, oropharynx, hypopharynx,
  larynx)

3
?????

• ??????????????????????????????????????????????????
  ??????????????????????
• ?????????????????????????? Direct laryngoscopy
  and rigid esophagoscope (conventional
  panendoscopy) ??????????????? ?????????????????

4
???????????????????? ?? ????????? DL
esophagoscopy ?? 2551
???????????? ?????? 14 ???/????? ???? 165
???/??
5
Flow process ???????
(??????????????? ?? ???? ???????)
At OPD ENT
3.??????? chief tumor ???????????????
???????????????? 7 (5-10) ????
1.????????????????? ??? v/s ????????????? 5
(3-5) ????
2.??????????? 20 (0-30) ????
6.??????? ???????????????
???????????????????? 10 (10-15) ????
4.?????????????? 10 (5-15) ????
5.Consult ??????? ???????? ??????????? 7
(5-10) ????
7.?????????? 5
(3-7) ????
8.???????? ????????.??????? D/L
esophagoscopy 10 (10-15) ????
9.????????? ????????????????? ???????? 20
(10-30) ????
6
????????. ??? OPD
1.???????? ????????? ??? v/s ???????????? 5
(3-15) ????
2. ??????????? 20 (10-30) ????
3.?????????????? admit 15 (5-20) ????
4.?????????? 7 (5-20) ????
6. ??????? 120 (5-360) ????
7.????? 50 (30-70) ????
5.???????? 7 (5-20) ????
8.??????????? 15 (10-20) ????
?????????
9. ????? 50 (30-70) ????
11.?????????? 40 (20-60) ????
12. ???????? 30 (30-45) ????
10. ?? OR 15 (10-20) ????
14. ???? ward 15 (10-20) ????
13. ????? 50 (30-70) ????
7
????????????

• ??????? 23 ???????
• ???????? 533 ????
• ?????????? 7,525 ???/???

8
Pre-lean
???????????????????? ????????????????????
????????? 131 x100 24.6
533
???????????????????????
9
???????????????????? Transnasal esophagoscopy
(TNE)

• ???????? ?????????????????????????????????????????
  ??????????????????? ?? ????
• ????????????????????? ?????? 100
  ?????????????????????????????? conventional
  panendoscopy
  (laryngoscope 2002, 1122242-3)

10
???????????????????? Transnasal esophagoscopy
(TNE)

• ?????
• Flexible fiberoptic endoscope
• ?????????? ????????? 5.1 ??.??????? 60 ??.
• ??????????? OPD
• ??????? sedate ???????
• ???????????? ??????? 20 ????
• ????????????????

• ?????????
• ????????????????????
• ??????? 4 xylocaine 5mL.
• ??????????????? (4 ephridine)
• ??????????? (4 xylocaine)
• ?? 3-5 ???? ????????????????????????? ???????????
  GEJ ???
• ?????? insufflation, irrigation ??? biopsy ???

11
Flow process ???????
(??????????????? ?? ???? ???????)
OPD ENT
3.??????? chief tumor ??????????
???????????????? 7 (5-10) ????
1.???????? ????????? ??? v/s ?????????????
5 (3-5) ????
2.??????????? 20 (0-30) ????
6.Consult ??????? ?????????????? 10
(10-15) ????
4.?????????????? 20(20-30) ????
5.????????? TNE 15 (10-20) ????
9.???????? ???????????.??????????
??????????????????/?????????/????? 10 (10-15) ????
8.?????????? 5 (3-7)????
7.??????? ???????????????????????????????? 10
(10-15) ????
10.????????? ?????????? ???????????????
20 (10-30) ????
12
????????????

• ??????? 10 ???????
• ???????? 122 ????
• ?????????? 1,300 ???/???

13
Post-lean
???????????????????? ???????????????????
?????????? 77 x100 61.1
???????????????????????
122
14
??????????????????????? DL esophagoscopy
??2551-2552
??????? TNE ?????? ?.?.-?.?. 52
????????????????????? ????????? 4 ??/?????
15
???????????????????? Pre and Post-Lean
Direct larygoscope Rigid esophagoscope
Transnasal Esophagoscope
?????????????????? Pre-lean Post-lean ???????????
Process 23 10 13
Total turn around time (min.) 533 122 411
Waiting time (min.) 372 45 327
Cost /case 7,525 1,300 6,225
??????????? 24.6 61.1 36.5
16
???????????????????? Pre and Post-Lean
TNE
D/L Esophagoscope
?????? Pre-lean Post-lean
Quality Rigid endoscope (direct laryngoscope, rigid esophagoscopy Flexible endoscope ?????? postcricoid ??? pyriform ?????????????????
Delivery ????? ENT ???????? ????? ENT ????????
Safety ?????????????????? ????????????????????????????? rigid endoscope ????????????????????
Moral Ethic ?????????????? ???????????? ??????????????????????
Others -??????????? -?????????????????? -???????????? loss F/U ??? -?????????.????????? 2??? -??????????? OPD (one-stop service) -??????? loss F/U ???????? -???????????????.
17
???????????????????

• ??????????????????????? TNE ????????????????????
  ????
• ????????? ????????????????? ??
  ?????????????????
• ???????????????? ????????????????????????????????
  
• ?????????????????????????????
• ??????????????????????????.
• ??????????????????.?????????????????????????

18
?????????????????????? Lean

• ???????????? ?????????????????????????????????????
  ? TNE
• Learning curve
• ???????????
• ????????? management guideline ??????????????? ??
  ??????????? ??????????????????????????????????????
  ????????????????

19
?????????????????????????????????? ?? ???? ???????
??????????????? ?? ???? ??????????????????????????
?????????????
?????????? chief tumor ??????????
???????????????? ?? ???? ???????????????????? TC
????????? ????????? ??????????? TNE ,
????????????????????????????????

• ???????????? tumor conference
• ????????????????????, work up lab ??? imaging
  ???? ????????.
• ????????????????????
• ?????????????????????????????????????????????????
  ????????????

20

• ???? TNE ????????????????????????? ??????
  ?????????????
• ?????????? ??? neck node unknown primary
• ??????????????? TNE
• ??????? impending airway
• ?????????????????? ???????????????? airway
  obstruction
• ??????????????????? postcricoid ???? pyriform
  ?????????????????????????? ??????????????????????
  ??????
• ?????????????????? TNE

21
Thank you