日间手术中的结直肠 ESD。
Colorectal ESD in day surgery.
机构信息
Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
出版信息
Surg Endosc. 2017 Sep;31(9):3690-3695. doi: 10.1007/s00464-016-5407-7. Epub 2017 Feb 8.
BACKGROUND
Colorectal endoscopic submucosal dissection (ESD) was developed in Japan and is growing in popularity in Europe. Patients undergoing a colorectal ESD procedure in Japan are hospitalized for several days. In this study, we investigated the feasibility of colorectal ESD as an outpatient procedure in a European setting.
METHODS
A prospective cohort of all patients undergoing colorectal ESD at Danderyds Hospital, Stockholm, Sweden from April 2014 to December 2015 were studied. Data on patient demographics, procedural outcome and 30-day readmissions were studied. Data are presented as median (range), mean ± SD or true numbers as appropriate.
RESULTS
A total of 182 patients underwent a colorectal ESD during the study period. Of the 182 these, 11 were scheduled for an in-hospital procedure and of 171 patients scheduled for a day-procedure and 15 were admitted for observation. The remaining 156 patients were discharged after 2-4 h of observation and comprise the study cohort. Mean age was 69 years. Median lesion size was 28 (10-120) mm, and median resection time was 65 (10-360) min. Lesions were located as follows: anal canal 1 (0.6%), rectum 52 (33.3%), sigmoid 17 (10.9%), descending 3 (1.9%), transverse 24 (15.4%), ascending 29 (18.6%), and cecum 30 (19.2%). Eight (5.1%) of the 156 day surgery patients returned for medical attention during the postoperative 30-day period. Three of them were admitted for in-hospital observation. None of the day surgery patients required any surgical intervention.
CONCLUSION
Uncomplicated colorectal ESD can safely be carried out in a day surgery setting.
背景
结直肠内镜黏膜下剥离术（ESD）最初在日本发展，目前在欧洲越来越受欢迎。在日本接受结直肠 ESD 手术的患者需要住院数天。本研究旨在探讨在欧洲环境下将结直肠 ESD 作为门诊手术的可行性。
方法
对 2014 年 4 月至 2015 年 12 月期间在瑞典斯德哥尔摩 Danderyds 医院接受结直肠 ESD 的所有患者进行前瞻性队列研究。研究了患者的人口统计学资料、手术结果和 30 天再入院情况。数据以中位数（范围）、均值 ± 标准差或实际数字表示。
结果
研究期间共有 182 例患者接受了结直肠 ESD。其中 11 例患者计划住院手术，171 例患者计划日间手术，15 例患者住院观察。其余 156 例患者观察 2-4 小时后出院，为研究队列。患者平均年龄为 69 岁。中位病变大小为 28（10-120）mm，中位切除时间为 65（10-360）min。病变部位如下：肛管 1 例（0.6%），直肠 52 例（33.3%），乙状结肠 17 例（10.9%），降结肠 3 例（1.9%），横结肠 24 例（15.4%），升结肠 29 例（18.6%），盲肠 30 例（19.2%）。在术后 30 天内，有 8 例（5.1%）日间手术患者因医疗需要返回。其中 3 例住院观察。无日间手术患者需要任何手术干预。
结论
结直肠 ESD 术如果没有并发症，可以安全地在日间手术环境下进行。
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