消化内镜日间手术适宜术式探索：1年850例次患者的经验分享

目的探讨消化内镜日间病房模式和日间手术适宜术式。 方法前瞻性收集2016年10月至2017年10月经解放军总医院第一医学中心消化科日间病房收治850例次患者的临床资料，分析其手术成功率、并发症发生率、转科率、住院总费用及药费比等指标。 结果850例次收治中，开展日间手术812例，手术成功率99.88%(811/812)。出血、穿孔等并发症5例，其发生率0.62%(5/812)，均内镜下成功处理，无1例转送外科手术。由于潜在出血风险，5例术后转入普通消化病房，转科率为0.59%(5/850)。消化内镜日间手术前5位的有：结直肠息肉切除术(525例)、胃息肉切除术(112例)、消化道狭窄内镜下治疗术(球囊/探条扩张/瘢痕松解术，86例)、胃食管早癌射频消融术(14例)、EUS/FNA和食管平滑肌瘤及乳头状瘤切除术(各12例)。 结论消化内镜日间开展胃肠息肉切除术、消化道狭窄内镜下治疗术、胃食管早癌射频消融术及EUS/FNA等手术，是安全、可行的。该消化内镜日间病房模式及开展术式，可为其他中心日间病房的开展与运行提供参考。

Safety and feasibility of endoscopic ambulatory procedures: one-year experience of 850 cases

ObjectiveTo explore the endoscopic ambulatory ward model and evaluate the safety and feasibility of endoscopic ambulatory procedures. MethodsA total of 850 cases of patients were admitted in our endoscopic ambulatory ward from October 2016 to October 2017.The clinical data of patients, such as operation success rate, adverse event rate, patient transfer rate, hospitalization expenses were recorded and analyzed. ResultsOf the 850 cases, 812 endoscopic ambulatory procedures were performed, and the success rate was 99.88%(811/812). Five cases experienced adverse events (2 immediate bleeding, 2 delayed bleeding, and 1 immediate perforation), but were managed endoscopically without asverse events in the follow-up.None was transferred to surgery.Due to potential risk of adverse events, 5 patients were transferred to general digestive ward and the transfer rate was 0.59%(5/850). The top 5 of endoscopic ambulatory procedures were colorectal polypectomy (525 cases), gastric polypectomy (112 cases), endoscopic dilation or resection for digestive tract stenosis (86 cases), endoscopic radiofrequency ablation for gastroesophageal superficial neoplasms(14 cases), EUS/FNA (12 cases) and endoscopic resection for esophageal leiomyoma or papilloma (12 cases). ConclusionsEndoscopic ambulatory procedures are safety and feasible, such as colorectal or gastric polypectomy, endoscopic dilation or resection for digestive tract stenosis, endoscopic radiofrequency ablation and EUS/FNA.Our endoscopic ambulatory ward model and procedures may provide reference for other centers.