内镜下食管黏膜剥离术后迟发性穿孔的危险因素分析  

Analysis of clinical risk factors of delayed perforation after esophageal endoscopic submucosal dissection

作　　者：吕修和 王春晖[1] 谢艳[1] 

机构地区：[1]四川大学华西医院消化内科,四川成都610041

出　　处：《胃肠病学和肝病学杂志》2015年第9期1100-1103,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金青年科学基金项目(81200333)

摘　　要：目的探讨食管黏膜病变经内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)后发生迟发性穿孔的危险因素。方法回顾性分析四川大学华西医院2010年3月-2014年7月因食管黏膜病变接受ESD治疗的145例患者的相关情况。首先,对迟发性穿孔的发生率和临床操作过程进行评价。其次,对以下各项变量做出统计分析:患者相关因素(年龄、性别、主诉症状、伴发疾病情况);病变相关因素(病变大小、部位、形态、深度和病理类型);操作相关因素(手术时间、使用刀型、黏膜下注射药品、病变切除情况)。结果发生迟发性穿孔7例(穿孔组),对应病变8处。与未发生穿孔的138例(非穿孔组,143处病变)相比,病变的纵向长度、环周直径、环周范围及手术时间与迟发性穿孔的发生高度相关。病变的环周范围(>3/4)是迟发性穿孔发生的预测因素。所有穿孔患者均经内科保守治疗后康复。结论病变范围越大越易导致食管ESD术后迟发性穿孔的发生。对于发生术后穿孔的患者,积极的内科保守治疗可明显促进患者的康复,避免不必要的外科手术治疗。Objective To investigate the clinical risk factors of delayed perforation after endoscopic submucosal dis-sect;on ESD） for esophageal mucosal lesions. Methods The correlative data of ESD treatment for 145 patients with e- sophageal mucosa lesions in West China Hospital of Sichuan University were retrospectively analyzed from Mar. 2010 to Jul. 2014. Firstly, the incidence of delayed perforation and clinical operation were evaluated. Then the following factors associated with delayed perforation were analyzed ： （ 1 ） patient-related factors ： age, sex, chief complaints, comorbidi- ties; （2） lesion-related factors： specimen size, shape, location, depth, pathological type; （3） procedure-related fac- tors： operation time, knife type, submucosal injection of drugs, excision of lesions. Results The longitudinal length, circumferential diameter, circumferential extension and operation time were highly correlated with the incidence of de- layed perforation. Univariate and multivariate analysis revealed that the circumferential extension （ 〉 3/4） was the pre- dictive factor of delayed perforation after esophageal ESD. Conclusion Larger size lesions would be more easier to result in esophageal ESD delayed perforation. For the patients with delayed perforation, positive conservative treatment can ob- viously promote the patients＇ rehabilitation, and avoid unnecessary surgical treatment.

关 键 词：内镜下黏膜剥离术 穿孔 危险因素 

分 类 号：R571[医药卫生—消化系统]