新型冠状病毒肺炎疫情期间择期胃肠镜检查结果分析  

Analysis of selective endoscopy results during the epidemic of coronavirus disease 2019(COVID-19)

作　　者：朱亮 蔡明琰 时强 王萍 李全林 钟芸诗 姚礼庆 周平红 Zhu Liang;Cai Mingyan;Shi Qiang;Wang Ping;Li Quanlin;Zhong Yunshi;Yao Liqing;Zhou Pinghong(Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华胃肠外科杂志》2020年第4期327-331,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：上海市“医苑新星”青年医学人才培养资助计划(沪卫计人事[2019]72号)。

摘　　要：目的探讨在新型冠状病毒肺炎(新冠肺炎)疫情期间开展胃肠镜诊疗(主要针对消化道恶性肿瘤)工作的必要性和安全性。方法采用回顾性队列研究方法,分析2020年2月20日至3月6日期间,于复旦大学附属中山医院内镜中心行门诊胃肠镜检查的病例资料(疫情期间诊疗组),包括新冠肺炎相关的流行病学调查表、临床主诉、内镜检查、活检病理结果等;所有医护人员行新型冠状病毒(COVID?19)血液IgM/IgG抗体检测,患者及家属行电话随访确定是否感染新冠肺炎。同时收集2019年2月20日至3月6日同期行门诊胃肠镜检查的病例资料作为对照组,以比较疫情期间胃肠镜检查的总体情况以及消化道恶性肿瘤检出情况。结果疫情期间诊疗组胃肠镜检查共计911例患者,而对照组胃肠镜检查共计5746例,是疫情期间诊疗组的6.3倍。疫情期间诊疗组胃镜检查544例,肠镜检查367例;而对照组胃镜检查3433例,肠镜检查2313例,分别均是疫情期间诊疗组的6.3倍。胃镜检查发现上消化道恶性肿瘤患者疫情期间诊疗组和对照组分别有39例(7.2%)和77例(2.2%),差异有统计学意义(χ^2=40.243,P<0.001);胃癌检出率两组分别为18例(3.3%)和59例(1.7%),差异有统计学意义(χ^2=6.254,P=0.012);食管癌检出率两组分别为20例(3.7%)和18例(0.5%),差异有统计学意义(χ^2=49.303,P<0.001)。疫情期间诊疗组和对照组肠镜检查发现结直肠癌分别为32例(8.7%)和88例(3.8%),差异有统计学意义(χ^2=17.888,P<0.001)。疫情期间,通过COVID?19血液IgM/IgG抗体检测,未发现医护人员感染,电话随访未发现患者检查后以及家属感染新冠肺炎。结论与2019年同期相比,疫情期间,胃肠镜检查量锐减,但消化道各种恶性肿瘤发现率均显著升高,提示对于出现消化道肿瘤高危症状的患者,仍应尽早接受胃肠镜检查。在严格遵循国家和专业学会制定的防疫标准前提下,尽早开展临床诊疗工作�Objective To explore the necessity and safety of selective endoscopy to detect gastrointestinal(GI)malignancy during the outbreak of coronavirus disease 2019(COVID?19).Methods A retrospective cohort study was carried out to analyze the clinical data of selective endoscopy performed at the Endoscopic Center,Zhongshan Hospital of Fudan University from February 20 to March 6,2020.Clinical data included epidemiological questionnaire,chief complaints,endoscopic findings and biopsy pathology results,etc.All medical staff had blood test for IgM/IgG antibodies of COVID?19.Patients and their families were followed up by phone to determine whether they were infected with COVID?19.Meanwhile,the clinical data of selective endoscopy during the same period from February 20 to March 6,2019 were collected as the control group to compare the overall results of endoscopy examinations during the epidemic and the detection rate of GI malignancy.Results A total of 911 patients underwent endoscopy in the epidemic period group,and a total of 5746 cases in the control group,which was 6.3 times over the epidemic period group.In the epidemic period group,544 cases received gastroscopy and 367 cases received colonoscopy,while 3433 cases received gastroscopy and 2313 cases received colonoscopy in the control group,which were both 6.3 times of epidemic period group.Gastroscopy revealed that 39 patients(7.2%)were diagnosed with upper GI malignancies in the epidemic period group and 77 patients(2.2%)in the control group with significant difference(χ^2=40.243,P<0.001).The detection rate of gastric cancer in these two groups was 3.3%(n=18)and 1.7%(n=59)respectively with significant difference(χ^2=6.254,P=0.012).The detection rate of esophageal cancer was 3.7%(n=20)and 0.5%(n=18)respectively with significant difference(χ^2=49.303,P<0.001).Colonoscopy revealed that colorectal cancer was found in 32 cases(8.7%)of the epidemic period group and 88 cases(3.8%)of the control group with significant difference(χ^2=17.888,P<0.001).During the epidemic

关 键 词：新型冠状病毒肺炎 胃肠镜检查 择期 恶性肿瘤 

分 类 号：R563[医药卫生—呼吸系统]