日间手术模式在内镜粘膜下剥离术患者中的安全性与有效性研究

Study on the Safety and Effectiveness of Daytime Surgical Mode in Patients Undergoing Endoscopic Submucosal Dissection

摘要: 目的：探讨日间手术模式在消化内镜ESD患者中的安全性与有效性研究。方法：选取青岛大学附属泰安市中心医院2023年1月至2024年4月纳入接受ESD诊疗服务的879例患者，为保证研究结论的准确性，最大程度的减少数据偏差，考虑到相较于传统住院ESD手术，日间ESD手术对患者年龄、病病变最大直径、是否有合并症等要求更严格，在879例患者中限定研究组和对照组年龄均≤70岁，限定病变最大直径均≤3 cm，同时两组均排除有严重合并症的患者进行数据分析，共排除151例，最终纳入728例，将研究对象分为研究组(行ESD日间手术的患者，108例)和对照组(常规住院手术的患者，620例)。通过比较两组患者生活质量、肠道功能恢复情况、术后并发症发生率、二次入院率、平均住院天数、药占比指标、患者总费用等社会经济效益、满意度及术后病理结果的差异。结果：与对照组相比，研究组术后GIQLI量表中自觉症状、生理功能、日常社会活动、心理情绪方面评分无明显差异；研究组术后6 h肠鸣音恢复、首次进食时间、肛门排气时间、排便时间无明显差异；研究组术后并发症发生率及二次入院等方面无明显差异；研究组术后临床疗效完全切除率、整块切除率无明显差异；P > 0.05。研究组的住院天数、药占比、总费用均低于对照组，患者满意度高于对照组，P < 0.05。结论：当日间手术应用于年龄 ≤ 70岁、病变最大直径 ≤ 3 cm且无严重合并症的消化内镜ESD患者时，日间手术有效性和安全性与常规手术相当，且有效缩短住院时间、降低医疗费用并改善患者满意度。

Abstract: Objective: Exploring the safety and effectiveness of daytime surgical mode in patients with digestive endoscopic ESD. Methods: 879 patients who received ESD diagnosis and treatment services at Tai’an Central Hospital affiliated with Qingdao University from January 2023 to April 2024 were selected. In order to ensure the accuracy of research conclusions and minimize data bias, considering that compared with traditional inpatient ESD surgery, daytime ESD surgery has stricter requirements for patient age, maximum diameter of disease lesions, and whether there are comorbidities, the study group and control group were both limited to an age of ≤70 years and a maximum diameter of lesions ≤ 3 cm. At the same time, 151 patients with severe comorbidities were excluded from both groups for data analysis. A total of 728 patients were finally included, and the study subjects were divided into the study group (108 patients who underwent ESD daytime surgery) and the control group (620 patients who underwent conventional inpatient surgery). By comparing the differences in social and economic benefits, satisfaction, and postoperative pathological results between two groups of patients in terms of quality of life, intestinal function recovery, incidence of postoperative complications, readmission rate, average length of hospital stay, drug proportion indicators, total patient costs, etc. Results: Compared with the control group, there was no significant difference in the postoperative GIQLI scores of the study group in terms of subjective symptoms, physiological function, daily social activities, and psychological emotions; There was no significant difference in the recovery of bowel sounds, first meal time, anal exhaust time, and defecation time among the research group 6 hours after surgery; There was no significant difference in the incidence of postoperative complications and secondary hospitalization among the research group; There was no significant difference in the complete resection rate and whole block resection rate of postoperative clinical efficacy in the research group; P > 0.05. The length of hospital stay, proportion of medication, and total cost of the research group were all lower than those of the control group, and patient satisfaction was higher than that of the control group, P < 0.05. Conclusion: When applied to digestive endoscopic ESD patients aged ≤70 years, with a maximum lesion diameter ≤ 3 cm and no serious complications, daytime surgery is as effective and safe as conventional surgery, and effectively shortens hospital stay, reduces medical costs, and improves patient satisfaction.