日间病房模式的内镜息肉冷切除术治疗老年人结直肠息肉的临床效果

Effect of endoscopic cold snare polypectomy in day ward mode in treatment of colorectal polyps in the elderly

摘要:

目的 探讨日间病房模式下，采用内镜息肉冷切除术治疗老年人结直肠息肉的有效性、安全性和满意度。方法 选取2020年3月－2021年3月在该院行肠息肉切除术的454例老年患者作为研究对象，将患者分为3组：日间病房冷切除组、日间病房热切除组和普通病房冷切除组。比较3组患者的临床特征、手术并发症、息肉复发率、住院时间、住院费用和住院满意度。结果 3组患者临床特征、组织病理学和术后并发症（出血、穿孔和复发率）比较，差异均无统计学意义（P > 0.05）；冷切除组的即刻出血率较高，电凝综合征为热切除组独有，热切除组的金属夹使用人数最多，普通病房冷切除组使用最少；日间病房组的住院时间短于普通病房组，费用低于普通病房组，但患者满意度方面，日间病房组低于普通病房组，差异均有统计学意义（P < 0.05）。结论 日间病房模式下，采用内镜息肉冷切除术治疗老年人结直肠息肉，安全、经济和有效。但是，由于在短时间内缺乏与患者的病情沟通，反而会导致患者住院满意度下降。

Abstract:

Objective To explore the curative effect of day care unit on the efficacy, safety and satisfaction of elderly patients who underwent a cold snare polypectomy for the treatment colorectal polyps.Methods Clinical data from 454 elderly patients with 824 colorectal polyps (Diameter 4 ~ 10 mm) who received a polypectomy from Mar 2020 to Mar 2021 were collected. These patients were classified into three groups. The cold snare polypectomy group and hot snare polypectomy group in day care unit, and the cold snare polypectomy group in general wards. The clinical characteristics, adverse events, recurrence, hospitalization time, and expenses, were compared among three groups. Additionally, the patients’ hospitalization satisfaction was investigated and analyzed.Results There were no significant differences in clinical characteristics, histopathology, and rates of postoperative bleeding, perforation, and recurrence among the 3 groups (P > 0.05), but the probability of immediate bleeding was higher in the cold snare polypectomy group. Moreover, coagulation syndrome was unique to the hot snare polypectomy group. The hot snare polypectomy group used the highest amount of endoclips, while the cold snare polypectomy group in the general wards used the least. Furthermore, the hospitalization time and expenses in the day care unit group were significantly lower than in the general wards group. However, the patients’ satisfaction survey showed that the day care unit group scored lower than the general wards group (P < 0.05).Conclusions It is safe, cost-effective and effective for elderly patients with colorectal polyps using cold snare polypectomy technique under the day care unit mode, but the lack of communication with the patient's condition in a short period of time rather leads to a decrease in hospital satisfaction.