早期胃癌患者内镜黏膜下剥离术后迟发性出血的发生率及影响因素:一项单中心观察性研究  

Incidence and Influencing Factors of Delayed Bleeding after Endoscopic Submucosal Dissection in Early Gastric Cancer Patients:A Single-Center Observational Study

作　　者：范磊 郭忠武 王斌 Fan Lei;Guo Zhongwu;Wang Bin(Department of Gastroenterology and Hepatology(Gastroscopy Room),Nanchong Physical and Mental Hospital,Nanchong 637770,Sichuan,China)

机构地区：[1]南充市身心医院消化肝病科(内镜室),四川南充637770

出　　处：《肿瘤预防与治疗》2025年第3期210-215,共6页Journal of Cancer Control And Treatment

摘　　要：目的:探讨早期胃癌(early gastric cancer,EGC)患者经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗后迟发性出血的发生率及影响因素。方法:连续纳入川北医学院附属南充市身心医院胃镜室2021年1月至2024年3月期间收治的210例行ESD治疗且病理诊断为EGC的患者为研究对象,收集患者的一般资料及临床资料,观察术后30 d内迟发性出血的发生情况并进行及时处理,计算ESD术后迟发性出血的发生率,并按照是否发生迟发性出血分为2组,采用Logistic回归模型分析EGC患者ESD术后发生迟发性出血的相关影响因素。结果:共纳入210例EGC患者,合计230处病变,ESD术后有28例患者,29处病变发生了迟发性出血,发生率为13.3%(28/210)。多因素Logistic回归分析显示:术前服用抗凝和(或)抗血小板药物(OR=5.205,95%CI:2.310~11.728,P<0.001)、手术时间≥60 min(OR=3.174,95%CI:1.298~7.763,P=0.011)、术中出血(OR=7.773,95%CI:2.876~21.005,P<0.001)、术前活检次数>2次(OR=6.620,95%CI:2.885~15.191,P<0.001)、病变形态为平坦型(OR=4.167,95%CI:1.404~12.361,P=0.010)是影响EGC患者ESD术后迟发性出血的独立危险因素。结论:术前服用抗凝和(或)抗血小板药物、手术时间≥60 min、术中出血、术前活检次数>2次、病变形态为平坦型是影响EGC患者ESD术后迟发性出血的独立危险因素。临床应针对上述因素采用干预方案,以降低术后迟发性出血的发生率。Objective:To investigate the incidence and influencing factors of delayed bleeding in patients with early gastric cancer(EGC)undergoing endoscopic submucosal dissection(ESD).Methods:A total of 210 EGC patients treated with ESD at the gastroscopy room of Nanchong Mental Health Center Affiliated to North Sichuan Medical College were consecutively enrolled as study participants between January 2021 and March 2024.General and clinical data of the patients were collected,and delayed bleeding occurring within 30 days postoperatively was monitored and promptly managed.The incidence of delayed bleeding following ESD was calculated.Patients were then divided into two groups based on the occurrence of delayed bleeding.A logistic regression model was used to analyze the influencing factors associated with delayed bleeding in EGC patients following ESD.Results:A total of 210 EGC patients were included,comprising 230 lesions.Delayed bleeding occurred in 28 patients and 29 lesions after ESD,with an incidence rate of 13.3%(28/210).Multivariate logistic regression analysis revealed that the following were independent risk factors for delayed bleeding after ESD in EGC patients:preoperative use of anticoagulant and/or antiplatelet drugs(OR=5.205,95%CI:2.310~11.728,P<0.001),surgical time≥60 minutes(OR=3.174,95%CI:1.298~7.763,P=0.011),intraoperative bleeding(OR=7.773,95%CI:2.876~21.005,P<0.001),preoperative biopsy frequency>2 times(OR=6.620,95%CI:2.885~15.191,P<0.001),and flat lesion morphology(OR=4.167,95%CI:1.404~12.361,P=0.010).Conclusion:Preoperative use of anticoagulant and/or antiplatelet drugs,surgical time≥60 minutes,intraoperative bleeding,preoperative biopsy frequency>2 times,and flat lesion morphology are independent risk factors for delayed bleeding after ESD in EGC patients.Intervention strategies should be implemented in clinical practice to address the aforementioned factors and reduce the incidence of delayed postoperative bleeding.

关 键 词：早期胃癌 内镜黏膜下剥离术 迟发性出血 影响因素 LOGISTIC回归模型 

分 类 号：R735.2[医药卫生—肿瘤]