住院、日间和门诊行内镜下治疗结直肠息肉患者的风险与效益对比分析  

Comparative analysis of the risks and benefits of endoscopic treatment in patients with colorectal polyps in hospital, day-care and outpatient settings

作　　者：徐鹏 王一飞 张丽航 王善娟 Xu Peng;Wang Yifei;Zhang Lihang;Wang Shanjuan(Department of Gastroenterology,the Central Hospital of Jiading affiliated to Shanghai Health Medical College,Shanghai 201800,China)

机构地区：[1]上海健康医学院附属嘉定中心医院消化内科

出　　处：《临床荟萃》2019年第9期837-842,共6页Clinical Focus

基　　金：上海市嘉定区科学技术发展基金——嘉定区重点学科资助项目(消化肿瘤方向)(2017ZD01)

摘　　要：目的研究结直肠息肉(息肉)行内镜下切除患者围手术期不同流程并发症发生情况、相关危险因素及经济效益比。方法回顾性研究2015年12月-2018年12月我院收治的内镜下治疗息肉患者1 720例,按随机数字表法分为住院组(588例,住院完善相关检查择期手术),仅检查血常规后直接切除患者分为两个亚组,日间组(659例,术后收日间病房),门诊组(473例,术后院外随访观察),对并发症发生率、相关危险因素、床位使用及费用等指标进行分析。结果术后发热住院组较其余两组升高(P<0.01)。腹部不适门诊组最低,与其余两组比较差异有统计学意义(P<0.01),日间组次之,与住院组比较差异有统计学意义(P<0.05)。肠道功能恢复时间和低血糖反应门诊组最少,与其余两组比较差异有统计学意义(P<0.05或P<0.01)。术中出血以升结肠和回盲部最为常见,其次为直肠,迟发性出血则以直肠最为常见,其次为升结肠和回盲部。无蒂型随息肉直径增加出血风险加大,1.0~2.0 cm范围息肉有蒂或亚蒂隆起型出血风险最高,而>2.0 cm范围则发生出血特别是迟发性出血风险最小,与其他类型比较差异有统计学意义(P<0.01),年龄最为显著增加出血风险,其次为收缩压水平和息肉直径,而高舒张压水平、手术史和全麻术式是出血风险保护因素。结论门诊行息肉内镜下治疗并不增加并发症风险,只需对高风险人群使用日间病房,对提高患者满意度及内镜复查依从性,节约医疗资源和降低医保费用有益。Objective To study the complications,relative risk factors and economic efficiency ratio in patients undergoing endoscopic resection of colorectal polyps(polyps) with different perioperative treatment scheme.Methods A retrospective analysis was conducted on 1 720 endoscopic polyp patients admitted to our hospital from December 2015 to December 2018, and according to the random number table method, the patients were divided into inpatient group(588 cases,performed selective operation after perfect inspection), patients with only routine blood tests performed resection directly were divided into two subgroups, day-care group(659 cases,postoperative admission to day-care ward),and outpatient group(473 cases,postoperative follow-up observation outside the hospital). The incidence of complications, related risk factors, bed use and cost were analyzed.Results The postoperative fever in the inpatient group was higher than the other two groups(P<0.01). Abdominal discomfort was the lowest in the outpatient group with statistically significant difference compared with the other two groups(P<0.01). The outpatient group was followed by the day care group, and there was tatistically significant difference between day care group and inpatient group(P<0.05). The outpatient group had the least intestinal function recovery time and hypoglycemic reaction, and the difference was statistically significant compared with the other two groups(P<0.05 or P<0.01). Intraoperative bleeding in ascending colon and ileocecal junction was the most common, followed by rectum.Delayed polypectomy bleedingin rectumwas the most common,followed by ascending colon and ileocecal junction. The risk of bleeding increased with the increase of adaxial polyp diameter, the risk of bleeding with pedicle or apically raised polyp in the range of 1.0-2.0 cm was the highest, while in the range that>2.0 cm was the lowest, especially with delayed polypectomy bleeding, which was significantly different compared with oter types(P<0.01). Age significantly increased th

关 键 词：结肠息肉 病房 并发症 经济学 医学 

分 类 号：R574.62[医药卫生—消化系统] R574.63[医药卫生—内科学]