上消化道上皮下病变行内镜治疗后并发症的危险因素  

Risk factors for complications of therapeutic endoscopy for upper gastrointestinal subepithelial lesions

作　　者：李佩余 黎思源 刘少俊[1] 张德才[1] LI Peiyu;LI Siyuan;LIU Shaojun;ZHANG Decai(Department of Gastroenterology,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院消化内科,长沙410013

出　　处：《中南大学学报（医学版）》2021年第3期278-282,共5页Journal of Central South University ：Medical Science

摘　　要：目的:研究上消化道上皮下病变(subepithelial lesions,SELs)行内镜治疗后并发症的危险因素。方法:回顾性分析2014年9月至2019年9月中南大学湘雅三医院消化内科上消化道SELs行内镜治疗[包括内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),内镜下胃壁全层切除术(endoscopic full-thickness resection,EFR),内镜黏膜下挖除术(endoscopic submucosal excavation,ESE),内镜黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)]后的184例患者的临床资料,分析术后并发症的危险因素。结果:在184例患者中,并发症组22例(包括迟发性出血3例、迟发性穿孔2例、电凝综合征17例),无并发症组162例。并发症组和无并发症组在性别、年龄、基础疾病、病变部位、病变累及层次、病理结果、内镜治疗方式、创面预防性封闭方面差异均无统计学意义(均P>0.05)。两组患者在病变直径≥40 mm、操作时间≥120 min、术中穿孔率的差异均有统计学意义(均P<0.05)。Logistic回归分析显示:病变直径≥40 mm和手术时间≥120 min为术后并发症发生的独立危险因素。结论:对于病变直径≥40 mm、手术时间≥120 min的内镜手术治疗的上消化道SELs患者,需要高度警惕术后并发症的发生。Objective:To study the risk factors for complications after endoscopic therapy for upper gastrointestinal subepithelial lesions(SELs).Methods:Retrospective analysis was performed on 184 patients in the Department of Gastroenterology in the Third Xiangya Hospital,Central South University after therapeutic endoscopy[endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFR),endoscopic submucosal excavation(ESE),and submucosal tunneling endoscopic resection(STER)]for the upper gastrointestinal SELs from 2014-09-01 to 2019-09-30.The clinic data were collected and risk factors for postoperative complications were analyzed.Results:Among the 184 patients,22 patients were in the complication group(including 3 cases of delayed bleeding,2 cases of delayed perforation,and 17 cases of electrocoagulation syndrome)and 162 patients were in the non-complication group.There was no significant difference between the complication group and the non-complication group in gender,age over 70 year,basic diseases,lesion location,lesion invasion layers,pathological results,endoscopic therapy,and preventive closure of wounds(all P>0.05).The differences between the two groups in lesion diameter over 40 mm,operative time over 120 minutes,and rate of intraoperative perforation were significant(all P<0.05).Logistic regression analysis showed that lesion diameter over 40 mm and operative time over 120 minutes were independent risk factors for postoperative complications.Conclusion:For the patients with upper gastrointestinal SELs after endoscopic minimally invasive therapy with the lesion diameter over 40 mm and the operative time over 120 minutes,it needs to highly alert to the occurrence of postoperative complications.

关 键 词：上皮下病变 钛夹 荷包缝合 并发症 危险因素 

分 类 号：R57[医药卫生—消化系统]