中国全科医学 ›› 2026, Vol. 29 ›› Issue (34): 5145-5152.DOI: 10.12114/j.issn.1007-9572.2023.0777

• 全科医生诊室 • 上一篇    

"全专结合"管理非常见疾病:以一例原发性中枢神经系统淋巴瘤为例

朱志宁, 顾洁, 范梅香, 黄延焱*()   

  1. 200040 上海市,复旦大学附属华山医院全科医学科
  • 收稿日期:2024-11-25 修回日期:2025-12-06 出版日期:2026-12-05 发布日期:2026-10-26
  • 通讯作者: 黄延焱

  • 作者贡献:

    朱志宁负责资料收集整理、文章起草、图片制作;顾洁负责文章的构思、整体设计和修订;范梅香负责文章格式修订;黄延焱负责文章设计、审阅和监督管理。

Managing Unusual Diseases Through the Integrated General-specialty Model: a Case Study of Primary Central Nervous System Lymphoma

ZHU Zhining, GU Jie, FAN Meixiang, HUANG Yanyan*()   

  1. Department of General Practice, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2024-11-25 Revised:2025-12-06 Published:2026-12-05 Online:2026-10-26
  • Contact: HUANG Yanyan

摘要: 全科医生的定位是社区的健康守门人,对签约及辖区内居民的健康情况有全面和持续的了解。全科医生不但需要有处理常见疾病的能力,还需要有识别和管理非常见疾病的能力。对于非常见疾病,社区全科医生面临两种挑战:一是部分非常见疾病的临床症状无特异性,当同时伴随基础疾病时,容易被漏诊。二是罹患非常见疾病患者在上级医院诊治后回到社区时,全科医生对此类疾病缺乏综合管理能力。作为全科医生,应该学会从生物、心理、社会、家庭等多种层面综合评估患者,促进疾病诊治及管理更加完善和全面。本文以一例罕见的原发性中枢神经系统淋巴瘤病例为例,通过全科医学科主导的多科室联合诊疗,经过手术、术后康复、疼痛管理和营养评定等逐渐好转,并制定家庭管理和后续治疗策略后离院,分享全科医学科通过"全专结合"管理非常见疾病的经验,以提升全科医生综合管理能力。

关键词: 神经淋巴瘤, 原发性中枢神经系统淋巴瘤, 全科医学, 全专结合模式, 非常见疾病

Abstract:

The role of a general practitioner is to serve as the gatekeeper of community health, maintaining long-term doctor-patient relationships and having a comprehensive and continuous understanding of the health status of residents in their jurisdiction. Therefore, general practitioners not only need to address common health issues but also require the ability to identify and manage uncommon diseases. In the case of uncommon diseases, general practitioners face two challenges. Firstly, the symptoms of some unusual diseases are often non-specific, and if there are underlying diseases, they are easily missed in the community. Secondly, even when patients return to the community after receiving treatment at a higher-level hospital, general practitioners may not have enough knowledge about certain diseases and lack the capacity for comprehensive management. As general practitioners, we need to assess patients comprehensively on multiple dimensions, including biological, psychological, social, and familial aspects, to provide more holistic care. This article describes a rare case of primary central nervous system lymphoma. Through the coordinated efforts of multiple departments under the leadership of general medicine, including surgery, postoperative rehabilitation, pain management, and nutritional assessment, the patient gradually improved. After formulating home care and follow-up treatment strategies, the patient was discharged. The article shares the experience of general medicine in managing uncommon diseases through a integrated general-specialty model approach, aiming to enhance the comprehensive management capabilities of general practitioners.

Key words: Neurolymphomatosis, Primary central nervous system lymphoma, General practice, Integrated general-specialty model, Unusual disease

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