内镜黏膜切除术出血的相关危险因素分析  

Risk factors for bleeding after endoscopic mucosal resection

作　　者：张志坚[1] 徐明符[1] 詹磊磊[1] 程树红[1] 陈孟君[1] 黄妙兴[1] 梁永强[1] 李嘉宝[1] 杜立钧[1] 

机构地区：[1]广东省东莞市人民医院,广东东莞523000

出　　处：《中国内镜杂志》2013年第6期566-570,共5页China Journal of Endoscopy

基　　金：2011年东莞市科技计划项目(No.201110515000312)

摘　　要：目的探讨内镜下黏膜切除术(EMR)出血发生的相关危险因素。方法纳入2010年1月～2012年1月在该院腔镜中心接受EMR治疗的患者378例(472处病灶),以术中出血和延迟出血为观察指标,通过Logistic回归探讨影响EMR出血的相关危险因素。结果①EMR术中出血的患者共31人(8.2%);Logistic多因素回归分析结果显示病灶位置、直径及黏膜下注射肾上腺素是影响EMR术中出血的独立危险因素。②EMR延迟出血的患者共12人(3.2%);K-M生存曲线分析结果显示延迟出血的患者中有11人(91.7%)出血发生在EMR术后2周内;Logistic多因素回归分析结果显示病灶直径、PPI使用是影响EMR术后延迟出血的独立危险因素。结论出血是EMR的并发症之一,对于位于食管、病灶直径较大的患者在EMR围手术期都应给予足够的重视。【Objective】To discuss the risk factors for bleeding under endoscopic mucosal resection.【Methods】 Overall 378 patients （472 locations） who received endoscopic mucosal resection in the endoscopy center of our hospital from January 2010 to January 2012 were recruited into this study. The main outcome measurement was immediate bleeding （occurring during the procedure） and delayed bleeding （after completion of the procedure and up to 30 days after procedure）. The risk factors for bleeding under endoscopic mucosal resection were discussed through logistic regression.【Results】Early bleeding occurred in 31 patients （8.2%）; In multivariate logistic regression analysis, location of the lesion, lesion diameter and submucosal injection of epinephrine were independent risk factors for early bleeding in EMR. Delayed bleeding occurred after the procedures in 12 patients （3.1% ）. Of those, 11patients （91.7%） bled with 2 weeks after EMR. In multivariate logistic regression analysis, lesion diameter and the use of PPI were independent risk factors for delayed bleeding in EMR. 【Conclusion】Bleeding is one of the complications in EMR, we should pay more attention to those patients whose lesion located in esophagus and/or the lesion is larger.

关 键 词：内镜黏膜切除术 出血 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]