内镜下治疗早期胃癌及癌前病变发生术后出血的临床分析  

Clinical analysis of postoperative bleeding after endoscopic treatment of early gastric cancer and precancerous lesions

作　　者：赵祥禄 崔艳欣[1] 管鑫[1] 姜相君[1] ZHAO Xianglu;CUI Yanxin;GUAN Xin;JIANG Xiangjun(Gastroenterology Department of Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao 266071,Shandong)

机构地区：[1]青岛市市立医院消化内二科,山东青岛266071

出　　处：《临床普外科电子杂志》2021年第4期37-44,共8页Journal of General Surgery for Clinicians(Electronic Version)

基　　金：青岛市科技惠民专项(20-3-4-4-4-nsh)。

摘　　要：目的探讨早期胃癌及癌前病变内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)术后发生出血的影响因素,并进行风险分层。方法收集2016年1月至2020年12月于青岛大学附属青岛市市立医院因早期胃癌及癌前病变行ESD治疗的手术病例,分析ESD术后发生出血的影响因素,并对与术后出血相关的影响因素进行赋分,根据评分进行风险分层,分为高危、中危、低危。结果237例早期胃癌患者经ESD治疗后发生术后出血13例(5.4%)。单因素分析显示,切除病灶大小、病变≥2个病灶、胃溃疡史、肝硬化史、恶性肿瘤史、阿司匹林服用史、氯吡格雷服用史、双联抗血小板药物服用史与ESD术后出血有关;多因素分析显示仅胃溃疡病史、切除病灶大小、恶性肿瘤史、双联抗血小板药物服用史是ESD治疗后出血的危险因素。结论胃溃疡病史、切除病灶大小、恶性肿瘤史、双联抗血小板药物服用史是ESD术后出血的危险因素,对于合并多种危险因素的患者,术前及时评估,ESD术中、术后要引起足够的重视,以预防术后出血。Objective To investigate the influencing factors of bleeding after endoscopic submucosal dissection(ESD)in early gastric cancer and precancerous lesions,and to conduct risk-stratification.Methods During January 2016 to December 2020,237 cases which experienced ESD surgery owing to early gastric cancer and precancerous lesions were collected in Qingdao Municipal Hospital Affiliated to Qingdao University.These cases were used to analyse influencing factors of bleeding after ESD.Additionally,influencing factors was scored and stratified into high-risk,intermediate-risk,and low-risk.Results 13 patients with early gastric cancer were bled after ESD,with an incidence of 4.5%.The size of resecting lesions,pathological changes≥2 lesions,the gastric ulcer history,the cirrhosis history,the therioma history,aspirin using history,clopidogrel using history,and dual antiplatelet therapy history were identified as influencing factors of bleeding after ESD by univariate analysis.Nevertheless,only gastric ulcer history,the size of resecting lesions,the therioma history,and dual antiplatelet therapy history were identified has a close relation with bleeding after ESD by multivariate Analysis.Conclusion Gastric ulcer history,the size of resecting lesions,therioma history,and dual antiplatelet therapy history are independent risk factor of bleeding after ESD.For patients with multiple risk factors,preoperative evaluation,intraoperative caution,and postoperative observation can effectively prevent postoperative bleeding.

关 键 词：内镜下黏膜剥离术 危险因素 早期胃癌 术后 出血 

分 类 号：R73[医药卫生—肿瘤]