门诊胃肠镜检查诊疗一体化模式探究  

Exploration of Integrated Diagnosis and Treatment Model for Outpatient Gastrointestinal Endoscopy

作　　者：李凯 汤杰 李琴 许丽亚 闵海洋 胥明 LI Kai;TANG Jie;LI Qin;XU Liya;MIN Haiyang;XU Ming(Department of Gastroenterology,Hongkou District Jiangwan Hospital,Shanghai,200081)

机构地区：[1]上海市虹口区江湾医院消化内科,200081

出　　处：《胃肠病学》2024年第8期460-464,共5页Chinese Journal of Gastroenterology

摘　　要：背景:胃肠道息肉是消化内科的常见、多发疾病,传统诊疗模式将内镜检查和治疗分两次进行,在一定程度上增加了患者的经济负担和时间成本,加重了医院的床位压力和医保支付压力。目的:探讨门诊胃肠镜检查诊疗一体化模式的可行性、安全性和优势所在。方法:连续收集2023年12月—2024年5月在上海市虹口区江湾医院消化内镜中心接受门诊胃肠镜检查诊疗一体化模式诊治胃肠道息肉患者的临床资料,分析其手术成功率、息肉完整切除率、再干预率、转入院率以及并发症发生情况和医疗费用节省情况。结果:共294例次患者纳入研究,男性144例,女性150例,平均年龄62.5岁;单发息肉107例,多发息肉187例。共切除胃肠道息肉622个,术式包括活检钳除(26.0%)、冷圈套器息肉切除术(52.1%)、热圈套器息肉切除术(9.0%)和内镜下黏膜切除术(12.9%),息肉平均直径6.4 mm,结直肠息肉占78.6%。内镜手术成功率和息肉完整切除率均为100%,再干预率和转入院率均为0。术后仅1例患者出现腹胀不适,予肛管排气后症状消失。其余患者无任何并发症发生。每例次患者平均节省医疗费用约1200元。结论:门诊胃肠镜检查诊疗一体化模式是一种安全、有效、可行的胃肠道息肉诊疗模式,可实现患者、医院和医保的“三赢”,可在进一步优化流程后推广应用。Background:Gastrointestinal polyps are a common and frequently seen condition in gastroenterology.In the traditional diagnosis and treatment model,endoscopy and polyp removal are performed in two separate procedures.This approach not only increases patients′financial and time burdens but also exacerbates hospital bed occupancy pressures and adds to the cost strain on healthcare insurance system.Aims:To explore the feasibility,safety,and advantages of an integrated diagnosis and treatment model for outpatient gastrointestinal endoscopy.Methods:Outpatients with gastro⁃intestinal polyps who underwent one⁃stop endoscopic examination and treatment from December 2023 to May 2024 at the Digestive Endoscopy Center of Shanghai Hongkou District Jiangwan Hospital were recruited consecutively.The clinical data were collected for analyzing the endoscopic surgery success rate,complete resection rate,re⁃intervention rate,hospitalization transfer rate,and the procedure⁃related complications.The healthcare cost saving for patients was calculated.Results:A total of 294 cases of patients were enrolled,including 144 male and 150 female,with mean age of 62.5 years old.One hundred and seven cases were single polyps,and 187 cases were multiple polyps.Six hundred and twenty⁃two polyps,mainly colorectal polyps(78.6%),were removed by using forcep polypectomy(26.0%),cold snare polypectomy(52.1%),hot snare polypectomy(9.0%),and endoscopic mucosal resection(12.9%).The average diameter of the polyps was 6.4 mm.Both the success rate of endoscopic surgical procedure and the complete resection rate were 100%.No re⁃intervention and hospitalization transfer were observed.Only one patient experienced post⁃procedure abdominal distension and discomfort,and the symptoms were resolved after anal deflation.The remaining patients developed no complications.On average,each case saved nearly 1200 RMB in medical expenses.Conclusions:The integrated diagnosis and treatment model for outpatient gastrointestinal endoscopy is a safe,effective and

关 键 词：胃肠镜检查 门诊医疗 诊疗一体化模式 安全 有效性 

分 类 号：R57[医药卫生—消化系统]