结直肠内镜黏膜下剥离术临床路径有效性评估。
Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection.
机构信息
Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
出版信息
World J Gastroenterol. 2012 Jul 28;18(28):3721-6. doi: 10.3748/wjg.v18.i28.3721.
AIM
To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD).
METHODS
This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups: mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 °C, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection.
RESULTS
A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 post-ESD. Complications were observed in 12.1% (23/189) of patients. Perforation occurred in 3.7% (7/189) of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding. We divided the subjects into 2 groups: tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P = 0.93, χ² test with Yates correction). The incidence of abdominal pain was 3.7% (7/189). All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A, and 7700 ± 2775 (cells/μL; ± SD) for group B, showing a statistically significant difference (P = 0.023, t-test). The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups (P = 0.54, t-test).
CONCLUSION
One-day admission is sufficient in the absence of complications during ESD or early post-operative bleeding.
目的
确定有效的住院时间作为内镜黏膜下剥离术（ESD）患者的临床路径。
方法
这是一项回顾性观察性研究，纳入了 2007 年 5 月至 2009 年 3 月期间在国家癌症中心医院接受 ESD 治疗的 189 例连续患者。患者分为两组：A 组患者住院 5 天出院，B 组患者住院时间超过 5 天。收集两组患者的以下数据：平均住院时间、肿瘤部位、肿瘤中位大小、ESD 后直肠出血需要紧急内镜检查、ESD 过程中或之后穿孔、腹痛、发热超过 38℃、ESD 前后炎症标志物血检阳性。数据收集后比较每个参数。
结果
所有患者中 83%（156/189）在 ESD 后第 3 天可以出院。12.1%（23/189）的患者出现并发症。3.7%（7/189）的患者发生穿孔。所有穿孔均发生在 ESD 过程中，并通过内镜夹闭进行处理。术后出血发生率为 2.6%（5/189）；所有病例均为直肠出血。我们将患者分为两组：肿瘤直径≥4cm 和＜4cm；两组之间无显著差异（P=0.93，Yates 校正的 χ²检验）。腹痛发生率为 3.7%（7/189）。所有病例均发生在手术当天或次日。A 组的中位白细胞计数为 6800±2280（细胞/μL；±SD），B 组为 7700±2775（细胞/μL；±SD），两组间差异有统计学意义（P=0.023，t 检验）。ESD 后第 1 天的平均 C 反应蛋白值，A 组为 0.4±1.3mg/dL，B 组为 0.5±1.3mg/dL，两组间无显著差异（P=0.54，t 检验）。
结论
在 ESD 期间或术后早期无并发症或出血的情况下，住院 1 天即可。
Zotero 插件