老年患者内镜下胃黏膜剥离术后迟发性出血的危险因素分析  

Risk factors of delayed bleeding after gastric endoscopic submucosal dissection in elderly patients

作　　者：刘建强[1,2] 王蓉[1,2] 李达周[1,2] 王雯[1,2] 张志坚[1,2] 林克荣[1,2] 李海涛[1,2] 江传燊[1,2] 

机构地区：[1]南京军区福州总医院消化内科 [2]福建医科大学福总临床医学院,福建福州350025

出　　处：《胃肠病学和肝病学杂志》2015年第10期1211-1214,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨老年患者胃黏膜病变内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)后迟发性出血的危险因素。方法回顾性分析行胃黏膜病变ESD的连续性老年患者的临床、内镜资料,采用单因素及多因素非条件Logistic回归分析ESD术后迟发性出血的相关危险因素。结果纳入研究的137例患者有15例(10.9%)发生ESD术后出血,其中11例于术后24 h内发生出血,4例于术后48 h内发生出血。对ESD术后迟发性出血的单因素Logistic回归分析结果表明,术前停用抗血栓药物<1周、长期使用非甾体类抗炎药(nonsteroidal anti-inflammatory drugs,NSAID)、病变位于贲门胃底、病变≥5 cm、活检次数>2次及局部合并溃疡或疤痕与术后迟发性出血显著相关(P<0.05)。进一步的多因素Logistic回归分析表明,术前停用抗血栓药物<1周、病变≥5 cm、活检次数>2次与术后迟发性出血显著相关(P<0.05)。结论术前停用抗血栓药物<1周、病变≥5 cm、活检次数>2次为老年患者ESD术后迟发性出血的危险因素,对于较大胃黏膜病变的老年患者于ESD术前应停用抗血栓药物>1周,而且应尽可能减少术前活检次数。Objective To investigate the risk factors of delayed bleeding after endoscopic submucosal dissection（ ESD） of gastric mucosal lesions in elderly patients. Methods A retrospective analysis was carried out on consecutive elderly patients with gastric disease who had undergone gastric ESD. The related risk factors of delayed bleeding after gastric ESD were analyzed by univariate and multivariate Logistic regression. Results A total of 137 patients were enrolled in this study. Fifteen patients（ 10. 9%） bleeding after gastric ESD,among whom 11 cases occurred within 24 hours after operation,4 cases occurred within 48 hours. Univariate Logistic regression analysis showed that withdrawal of antithrombotic agents less than 1 week,continued use of nonsteroidal anti-inflammatory drugs（ NSAID）,lesion was located at cardia,lesion size more than 5 cm,biopsied more than 2 times combined with ulcer or scar were significantly related with delayed bleeding after ESD（ P〈0. 05）. In the following multivariate Logistic regression,only withdrawal of antithrombotic agents less than 1 week,lesion size more than 5 cm and biopsied more than 2 times were significantly related with delayed bleeding after ESD procedure（ P〈0. 05）. Conclusion Withdrawal of antithrombotic agents less than 1 week,lesion size more than 5 cm and biopsied more than 2 times were risk factors for delayed bleeding after gastric ESD in elderly patients. Therefore,to an elderly patient with large gastric mucosal lesion,withdrawal of antithrombotic agents should more than 1 week and the biopsy times should be controlled as low as possible before ESD procedure.

关 键 词：内镜黏膜下剥离术 并发症 迟发性出血 危险因素 

分 类 号：R573[医药卫生—消化系统]