Hirasaki Shoji, Tanimizu Masahito, Moriwaki Toshikazu, Hyodo Ichinosuke, Shinji Toshiyuki, Koide Norio, Shiratori Yasushi
Department of Internal Medicine, Shikoku Cancer Center, Matsuyama.
Intern Med. 2004 Dec;43(12):1120-5. doi: 10.2169/internalmedicine.43.1120.
Recently, the cases of early gastric carcinomas which can be treated by endoscopic submucosal dissection (ESD) method have been increasing in our institute. Simple and precise guidelines for treating mucosal gastric carcinoma are necessary for improving the treatment outcome of this disease. In our institute, ESD using an insulated-tip diathermic knife (IT-ESD) was introduced for the treatment of mucosal gastric carcinoma in 1996. The purpose of this study was to evaluate the impact of a clinical pathway and standardize the treatment for mucosal gastric carcinoma treated with IT-ESD.
The Clinical Pathway and standardized of treatment for mucosal gastric carcinoma treated with IT-ESD were introduced at our institute in January 2002. We compared the length of hospitalization, total costs, hospital costs, operation time and bleeding rate during the 18 months before and after January 2002.
There was no significant difference in the clinical characteristics of the 20 patients in the control group and the 23 patients in the pathway group. There were 9 and 13 bleeding cases in the respective groups. The mean length of hospitalization, total costs and hospital costs were significantly less for patients in the pathway group. There was no significant difference in the operation time or bleeding rate among the two groups.
Our clinical pathway and the standardization of treatment for mucosal gastric carcinoma treated with IT-ESD proved effective for treating patients with mucosal gastric carcinoma and for minimizing the length of hospitalization without compromising patient care.
近来，我院可通过内镜黏膜下剥离术（ESD）治疗的早期胃癌病例数不断增加。为改善该疾病的治疗效果，需要简单而精确的黏膜型胃癌治疗指南。1996年，我院引入了使用绝缘头电刀的内镜黏膜下剥离术（IT-ESD）来治疗黏膜型胃癌。本研究的目的是评估临床路径的影响，并规范采用IT-ESD治疗黏膜型胃癌的治疗方法。
2002年1月，我院引入了IT-ESD治疗黏膜型胃癌的临床路径和标准化治疗方法。我们比较了2002年1月前后18个月期间的住院时间、总费用、住院费用、手术时间和出血率。
对照组的20例患者与路径组的23例患者在临床特征方面无显著差异。两组分别有9例和13例出血病例。路径组患者的平均住院时间、总费用和住院费用显著更低。两组之间的手术时间或出血率无显著差异。
我们的临床路径以及采用IT-ESD治疗黏膜型胃癌的治疗标准化，被证明对治疗黏膜型胃癌患者以及在不影响患者护理的情况下将住院时间减至最短是有效的。
