上消化道内镜治疗致医源性食管贲门黏膜撕裂症的影响因素  

Risk factors for iatrogenic Mallory-Weiss tear during upper endoscopy

作　　者：陈莹[1] 周炳喜 李亚其 袁媛[1] 李晓芳 CHEN Ying;ZHOU Bingxi;LI Yaqi;YUAN Yuan;LI Xiaofang(Department of Gastroenterology,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院河南省人民医院消化内科

出　　处：《中华实用诊断与治疗杂志》2020年第1期56-58,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关项目(142102310501)

摘　　要：目的探讨上消化道内镜治疗导致医源性食管贲门黏膜撕裂症(Mallory-Weiss tear,MWT)发生的影响因素。方法上消化道内镜治疗后发生医源性MWT患者50例为MWT组,未发生医源性MWT患者100例为对照组,比较2组临床特征,多因素logistic回归分析上消化道内镜治疗后发生医源性MWT的影响因素。结果MWT组年龄[(66±13)岁]较对照组[(55±14)岁]大(P<0.05),手术时间[70.00(30.75,112.00)min]较对照组[14.00(10.00,25.75)min]长(P<0.05),手术部位位于胃窦/十二指肠比率(66.0%)、行内镜黏膜下剥离术及经内镜逆行性胰胆管造影术比率(34.0%、44.0%)较对照组(42.0%、9.0%、18.0%)高(P<0.05);MWT组体质量指数[(23.58±2.02)kg/m^2],男性比率(56.0%),有糖尿病、反流性食管炎/贲门炎、腹部手术史比率(6.0%、12.0%、28.0%)与对照组[(24.13±3.19)kg/m^2、47.0%、10.0%、11.0%、26.0%)比较差异无统计学意义(P>0.05);多因素logistic回归分析结果显示,年龄(OR=3.011,95%CI:1.329~6.818,P=0.008)、手术时间(OR=1.031,95%CI:1.012~1.050,P=0.001)、手术部位位于胃窦十二指肠(OR=29.194,95%CI:2.633~323.655,P=0.006)是发生医源性MWT的影响因素。结论年龄、手术部位、手术时间是医源性MWT发生的影响因素。Objective To investigate the risk factors for iatrogenic Mallory-Weiss tear(MWT)caused by upper endoscopy.Methods The baseline clinical characteristics were compared between 50 patients with iatrogenic MWT after upper endoscopy(MWT group)and 100 patients without MWT(control group).The influencing factors for iatrogenic MWT caused by upper endoscopy were analyzed by using multivariate logistic regression models.Results MWT group had older age((66±13)years),longer operation lasting time(70.00(30.75,112.00)min),and higher percentages of surgical site in the antrum/duodenum(66.0%),endoscopic submucosal dissection(34.0%)and endoscopic retrograde cholangiopancreatography(44.0%)than control group((55±14)years,14.00(10.00,25.75)min,42.0%,9.0%,18.0%)(P<0.05).There were no significant differences in the body mass index((23.58±2.02)kg/m^2 vs.(24.13±3.19)kg/m^2),percentage of males(56.0%vs.47.0%),and percentages of diabetes,reflux esophagitis/carditis and history of abdomen operation(6.0%,12.0%,28.0%vs.10.0%,11.0%,26.0%)between two groups(P>0.05).Multivariate logistic regression analysis showed that the age(OR=3.011,95%CI:1.329-6.818,P=0.008),operation lasting time(OR=1.031,95%CI:1.012-1.050,P=0.001)and operation site in the antrum and duodenum(OR=29.194,95%CI:2.633-323.655,P=0.006)were the influencing factors for iatrogenic MWT.Conclusion The old age,operation site,and operation lasting time are the risk factors for iatrogenic MWT.

关 键 词：食管贲门黏膜撕裂症 上消化道内镜 医源性 影响因素 

分 类 号：R571[医药卫生—消化系统]