内镜黏膜下剥离术治疗早期胃癌术后延迟出血的危险因素分析  

Risk factors of delayed bleeding after endoscopic submucosal dissection for early-stage gastric cancer

作　　者：陈旭峰 向正国 杨胜兰 汤小龙 宗刚军 张妮娜 CHEN Xufeng;XIANG Zhengguo;YANG Shenglan;TANG Xiaolong;ZONG Gangjun;ZHANG Nina(Department of Gastroenterology,904th Hospital of Joint Logistics Support Force,Wuxi,214044,China;department of Gastroenterology,Nanjing Gulou Hospital)

机构地区：[1]联勤保障部队第904医院消化内科,江苏无锡214044 [2]南京鼓楼医院消化内科

出　　处：《中国中西医结合消化杂志》2021年第12期904-908,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：江苏省科技项目合同(No:BK20201139)。

摘　　要：目的:探讨内镜黏膜下剥离术(ESD)治疗早期胃癌术后延迟出血的危险因素。方法:回顾性分析2016年6月—2020年12月行ESD的205例早期胃癌患者的临床资料,收集患者基线资料、临床特征、出血情况。将患者分为出血组和未出血组,出血组又分为早期出血组(≤术后24 h)和晚期出血组(>术后24 h),分别采用两独立样本t检验或Mann-Whitney U检验进行术后延迟出血单因素分析,采用二元Logistic回归逐步回归法分析术后延迟出血的独立危险因素。结果:共18例(8.8%)患者发生术后延迟出血,其中10例(4.9%)为早期出血,8例(3.9%)为晚期出血。单因素及多因素分析结果显示,病灶直径≥2 cm、操作时间≥25 min、病变部位位于下1/3胃、使用过氯吡格雷的患者术后早期延迟出血的发生率较高。病变部位位于上2/3胃、氯吡格雷的使用是晚期出血的独立危险因素。结论:ESD术后早期应重点关注病灶直径≥2 cm、操作时间≥25 min、病变部位位于下1/3胃、使用过氯吡格雷的患者群体,而对于病变部位位于上2/3胃的患者,尤其关注晚期出血。Objective: To investigate the risk factors of delayed bleeding after endoscopic submucosal dissection(ESD) for early gastric cancer. Methods: Clinical data of 205 patients with early gastric cancer who underwent endoscopic submucosal dissection in our hospital from June 2016 to December 2020 were retrospectively analyzed, and baseline data, clinical characteristics and bleeding conditions of the patients were collected. Patients were divided into the bleeding group and the non-bleeding group, and the bleeding group was further divided into the early bleeding group(≤24 h after surgery) and the late bleeding group(>24 h after surgery). Univariate analysis of delayed postoperative bleeding was performed by two independent sample t test or Mann-Whitney U test, respectively. The independent risk factors of delayed postoperative bleeding were analyzed by binary Logistic regression. Results: A total of 18 patients(8.8%) experienced delayed postoperative bleeding, including 10 patients(4.9%) with early bleeding and 8 patients(3.9%) with late bleeding. Univariate and multivariate analysis results showed that patients with lesion diameter ≥2 cm, operation time ≥25 min, lesion location in the lower 1/3 of the stomach and clopidogrel had a higher incidence of early postoperative delayed bleeding. The lesion was located in the upper 2/3 of the stomach, and clopidogrel use were independent risk factors for late bleeding. Conclusion: Early postoperative attention should be paid to the patients with lesion diameter ≥2 cm, operation time ≥25 min, lesion location in the lower 1/3 of the stomach and clopidogrel use, and for late bleeding, attention should be paid to the patients with lesion location in the upper 2/3 of the stomach.

关 键 词：胃癌 内镜黏膜下剥离术 出血 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]