内镜下黏膜切除术或剥离术治疗结肠表浅肿瘤性病变并发电凝综合征临床表现及危险因素分析  

Clinical features and risk factors of coagulation syndrome after endoscopic mucosal resection or endoscopic submucosal dissection for colon superficial neoplastic lesions

作　　者：张其胜[1] 徐建华[1] 高鹏[1] 申玉翠 

机构地区：[1]上海交通大学附属上海市第一人民医院分院消化内科,上海200081

出　　处：《胃肠病学和肝病学杂志》2015年第7期799-801,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的分析内镜下黏膜切除术(EMR)或剥离术(ESD)治疗结肠表浅肿瘤性病变并发的电凝综合征(PPCS)的临床表现和治疗经过,及可能的危险因素。方法 512例因结肠表浅肿瘤性病变在上海市第一人民医院分院行EMR或ESD的住院患者为研究对象,排除有明确肠穿孔和出血并发症的患者,共有486例入选。患者分为EMR或ESD术后PPCS组,和有一个正常的临床过程的正常对照组,对比分析找出PPCS的危险因素。结果共有20例患者在EMR或ESD术后发生PPCS,发生率为4.1%,其中17例(85.0%)患者腹痛,14例(70.0%)患者发热,13例(65.0%)患者白细胞计数升高,20例(100%)患者C反应蛋白升高。PPCS组平均手术时间(50.2±18.6)min长于正常对照组(30.2±10.9)min(P<0.05);平均肿瘤大小(21.3±13.2)mm大于正常对照组(11.4±4.3)mm(P<0.05)。当因内镜下手术所致的创面面积>10 mm×10 mm时,PPCS发生率明显升高(P<0.05)。所有患者均很快康复,不需要外科手术干预。结论结肠表浅肿瘤性病变在行EMR或ESD后,PPCS发生率较高,且更容易发生于较大的肿瘤、更长的手术时间和更大的创面面积的患者。Objective To analyze the clinical features and risk factors of post-polypetomy coagulation syndrome（ PPCS） developing after endoscopic mucosal resection（ EMR） or endscopic submucosal dissection（ ESD） for colon superficial neoplastic lesions. Methods Data of patients who underwent EMR or ESD for colon superficial neoplastic lesions in Branch of Shanghai First People＇s Hospital were analyzed retrospectively. The incidence,clinical features of PPCS cases were analyzed. Additionally,patients who developed PPCS were compared with controls that had a normal clinical course,in order to assess for possible risk factors. EMR or ESD procedures were performed in the typical sequence（ marking,incision,and submucosal dissection）. Results Four hundred and eighty-six patients were included in this analysis. PPCS occurred after EMR or ESD in 20（ 4. 1%） patients. Among them,there were abdominal pain 17（ 85. 0%） patients,fever 14（ 70. 0%） patients,elevated WBC count 13（ 65. 0%） patients and raised C reactive protein 20（ 100%） patients. In the PPCS group,the median procedure time was longer than normal control group（ P〈0. 05）; the median tumor size was larger than normal control group（ P〈0. 05）. When wound area of EMR or ESD increased,the rate of PPCS rose correspondingly（ P〈0. 05）. All patients with PPCS presented with a favorable outcome,treated medically without the need for surgical interventions. Conclusion PPCS occurred with an incidence of 4. 1%after EMR or ESD for colon superficial neoplastic lesions,and the risk factors associated with PPCS include tumor size,procedural duration,and wound area. Patients may be reassured by the excellent prognosis of PPCS.

关 键 词：内镜下黏膜切除术 内镜下黏膜剥离术 并发症 电凝综合征 

分 类 号：R735.3[医药卫生—肿瘤]