内镜黏膜下剥离术后内镜复查依从性的现状研究

A cross‑sectional survey of patients'' compliance of endoscopic surveillance after endoscopic submucosal dissection

摘要:

目的 了解内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）后患者内镜复查依从性的现状及其影响因素。方法 本研究为横断面研究，采用普查方式，通过问卷调查联合电话回访采集2014年1月—2015年12月在空军军医大学西京消化病院行ESD治疗的患者资料，问卷调查时间从2019-05-01开始，截至2020-07-31。整理分析患者内镜复查依从性的现状及影响患者复查的原因，使用Logistic回归模型进行多因素分析寻找影响内镜复查依从性的独立危险因素。结果 共收集到413例患者的调查问卷，其中331例（80.1%）内镜复查依从性好，82例（19.9%）内镜复查依从性差。单因素分析显示性别构成（χ2=4.68，P=0.034）、病变性质构成（χ2=10.10，P=0.002）、文化程度构成（χ2=4.00，P=0.049）、可支配收入构成（χ2=7.00，P=0.009）、工作状况构成（χ2=11.29，P=0.004）、医疗保险种类构成（χ2=13.59，P=0.001）影响患者内镜复查依从性。Logistic回归分析结果显示：在相同种类的医疗保险下，黏膜下病变患者比黏膜病变患者达到依从性好的可能性更低（P<0.001，OR=0.383，95%CI：0.227～0.644）；在相同的病变性质下，城镇医疗保险患者比农村合作医疗保险患者达到依从性好的可能性更高（P<0.001，OR=2.938，95%CI：1.696～5.090）。结论 ESD术后患者内镜复查的依从性与病变性质、医疗保险种类和对疾病认知密切相关。黏膜下病变患者和农村合作医疗保险患者更有可能依从性不佳，应多加重视；同时，加强患者疾病认知教育，对提高复查依从性非常必要。

Abstract:

Objective To investigate patients"" compliance of endoscopic surveillance after endoscopic submucosal dissection (ESD) and the influencing factors. Methods This study was a cross-sectional survey. The data of patients who underwent ESD in Xijing Digestive Hospital of Air Force Military Medical University from January 2014 to December 2015 were collected through questionnaire and telephone call. The questionnaire survey was conducted from May 1, 2019 to July 31, 2020. Patients"" compliance for endoscopic surveillance and influencing factors were evaluated. Logistic regression model was used for multivariate analysis to determine independent risk factors affecting compliance of endoscopic surveillance. Results A total of 413 questionnaires were collected, of which 331 (80.1%) patients were well complied with endoscopic surveillance, and 82 (19.9%) were not. Univariate analysis showed that gender (χ2=4.68, P=0.034), lesion type (χ2=10.10, P=0.002), educational background (χ2=4.00, P=0.049), disposable income (χ2=7.00, P=0.009), employment (χ2=11.29, P=0.004) and medical insurance (χ2=13.59, P=0.001) affected patients"" endoscopic surveillance compliance. Logistic regression analysis indicated that patients with submucosal lesions were less likely to be compliant than patients with mucosal lesions with the same type of medical insurance (P<0.001, OR=0.383, 95%CI: 0.227-0.644); and with the same lesion type, patients with urban medical insurance were more likely to be compliant than those with rural cooperative medical insurance (P<0.001,OR=2.938, 95%CI: 1.696-5.090). Conclusion The endoscopic surveillance compliance for post-ESD patients is related to the lesion type, the type of medical insurance, and the awareness of the disease. More attention should be paid to those with submucosal lesions and rural cooperative medical insurance due to their poor compliance. And it is necessary to improve health education on the disease for better surveillance compliance.