胃间质瘤经黏膜下隧道内镜肿瘤切除术后出血的危险因素分析  

Risk factors for postoperative bleeding after submucosal tunneling endoscopic resection of gastric stromal tumor

作　　者：李云[1] 刘超[1] 刘琳 夏秀丽 徐超[1] 闫玲新 LI Yun;LIU Chao;LIU Lin;XIA Xiu-li;XU Chao;YAN Ling-xin(First Ward of Gastroenterology Department,Handan Central Hospital,Handan Hebei 056001,China;Second Ward of Gastroenterology Department,Handan Central Hospital,Handan Hebei 056001,China)

机构地区：[1]邯郸市中心医院消化内科一病区,河北邯郸056001 [2]邯郸市中心医院消化内科二病区,河北邯郸056001

出　　处：《局解手术学杂志》2021年第6期502-505,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省2019年度医学科学研究课题(20190198)。

摘　　要：目的分析经黏膜下隧道内镜肿瘤切除术(STER)治疗胃间质瘤的临床疗效及影响术后出血的危险因素。方法选择行STER治疗的251例胃间质瘤患者作为研究对象,分析STER的临床治疗效果及术后迟发性出血的发生情况。依据STER术后有无出血将患者分为出血组和未出血组,并采用单因素及多因素Logistic回归分析胃间质瘤STER术后出血的危险因素。结果251例胃间质瘤患者均顺利完成STER,整块切除率达100%(251/251),未见肿瘤残留,随访1年未发现远处转移、新发肿瘤或死亡病例;术后病理结果显示239例(95.2%)CD117阳性,241例(96.0%)DOG-1阳性,134例(53.4%)CD34阳性,16例(6.4%)S-100蛋白阳性;术后12 h~14 d发生创面出血的患者有27例(10.8%)。单因素分析显示年龄、病变部位、瘤体最大径、术中明显出血、手术者操作熟练程度是与STER术后出血有关的危险因素;多因素Logistic回归分析结果显示,病变部位为贲门—胃底、瘤体最大径≥4 cm、手术者操作不熟练是STER术后出血的独立危险因素。结论STER治疗胃间质瘤效果理想,但术后出血的发生率较高,影响STER术后出血的危险因素包括病变部位、瘤体最大径、手术者操作熟练程度等。Objective To analyze the clinical effect of submucosal tunneling endoscopic resection(STER)in the treatment of gastric stromal tumor and the risk factors for postoperative hemorrhage.Methods A total of 251 patients with gastric stromal tumor who underwent STER were selected as the study subjects,and the clinical treatment effect of STER and the occurrence of postoperative delayed bleeding were analyzed.These patients were divided into the non-bleeding group and the bleeding group according to the presence or absence of bleeding after STER,and the univariate and multivariate Logistic regression were used to analyze the risk factors of bleeding after STER for gastric stromal tumor.Results All the 251 patients with gastric stromal tumor successfully completed STER,and the whole resection rate was 100%(251/251).No residual tumor was found,and no distant metastasis,new tumor or death case was found during the 1-year follow-up.Postoperative pathological results showed that 239 cases(95.2%)were positive for CD117,241 cases(96.0%)were positive for DOG-1,134 cases(53.4%)were positive for CD34,and 16 cases(6.4%)were positive for S-100 protein.There were 27 patients(10.8%)of wound bleeding occurred 12 hours to 14 days after surgery.Univariate analysis showed that age,lesion site,maximum diameter of tumor,obvious intraoperative bleeding and operative skill were the risk factors related to postoperative hemorrhage of STER.Multivariate Logistic regression analysis showed that the lesion site was from the cardia to the fundus of the stomach,the maximum diameter of the tumor≥4 cm,and the unskilled operation of the operator were the independent risk factors for postoperative hemorrhage of STER.Conclusion STER has an ideal effect in the treatment of gastric stromal tumor,but the incidence of postoperative bleeding is relatively high.The risk factors affecting postoperative bleeding of STER include lesion site,maximum diameter of tumor,and the operative proficiency,etc.

关 键 词：内镜 经黏膜下隧道内镜肿瘤切除术 胃间质瘤 术后出血 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]