摘要
目的分析影响早期胃癌内镜黏膜下剥离术(ESD)和内镜黏膜切除术(EMR)术后出血的可能影响因素。方法回顾性收集2013年1月至2018年5月于北京友谊医院内镜中心因早期胃癌而行ESD/EMR治疗患者的临床资料,包括患者基本信息(年龄、性别、疾病史)、临床特征(病变大小、部位、形态)及术后病理信息(病理类型、浸润深度)等,分析ESD/EMR术后发生出血的影响因素。结果共有195例早期胃癌患者纳人研究,其中9例(4.6%)发生术后出血。术后出血病例与未出血病例相比.氯吡格雷服药史和主要病变大小在两组间分布差异有统计学意义(P=0.018及P=0.034)。多因素分析显示氯吡格雷服药史(0R=10.223,95%CI:1.143-91.468,P=0.038)、有多发病变(0R=6.412,95%CI:1.123-36.616,P=0.037)及主要病变m2cm(OR=6.718,95%CI:1.130-39.935,P=0.036)是术后发生出血的独立危险因素。生存分析结果显示:有氯吡格雷服药史(P<0.001)、主要病变M2cm的患者(P=0.022),ESD/EMR术后发生出血的风险明显增高。结论ESD/EMR术后应重点关注有氯吡格雷服药史、病变部位多发、病变较大的患者的出血风险。
Objective To analyze the possible influencing factors of postoperative bleeding after endoscopic submucosal dissection and endoscopic mucosal resection ( ESD/EMR) for early gastric cancer. Methods Clinical data of patients receiving ESD/EMR for the diagnosis of early gastric cancer at the Endoscopy Center of Beijing Friendship Hospital from January 2013 to May 2018, including demographic information ( age, gender and history), endoscopic lesion characteristics ( tumor size, location and morphology) and postoperative pathological features ( differentiated types and invasive depth) were collected to analyze the effects of these factors on bleeding after ESD/EMR. Results A total of 195 patients with early gastric cancer were included in the study and 9 cases ( 4. 6%) had postoperative bleeding. The medication history of clopidogrel and main lesion sizes were statistically different between postoperative bleeding group and non-bleeding group (P= 0. 018 and P = 0. 034). Multivariate analysis showed a history of clopidogrel (OR= 10. 223, 95% CI: 1. 143-91.468, P = 0. 038), multiple lesions ( OR = 6.412, 95% CI- 1. 123- 36. 616, P = 0. 037) and lesions sizes of larger than 2 cm ( OR = 6. 718, 95%CI:1. 130-39. 935, P = 0. 036) were possible risk factors for postoperative bleeding. Survival analysis showed of higher postoperative bleeding risks in patients with the history of clopidogrel (P<0. 001) and lesions sizes of more than 2 cm (P=0. 022). Conclusion More attention should be paid to the risk of ESD/EMR postoperative bleeding in early gastric cancer patients with medication history of clopidogrel and multiple large lesions.
作者
刘思
张倩
邢洁
孙秀静
朱敏
郭俊峰
朱圣韬
李鹏
张澍田
Liu Si;Zhang Qian;Xing Jie;Sun Xiujing;Zhu Min;Guo Junfeng;Zhu Shengtao;Li Peng;Zhang Shutian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Faculty of Gastroenterology of Capital Medical University,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China)
出处
《中华消化内镜杂志》
CSCD
北大核心
2019年第8期552-557,共6页
Chinese Journal of Digestive Endoscopy
基金
国家科技部国家重点研发计划(2017YFC0113600)
首都卫生发展科研专项项目(2016-1-2022)
北京市医院管理中心消化内科学科协同发展中心专项项目(XXZ01,XXZ02).
关键词
内镜下粘膜切除术
危险因素
内镜黏膜下剥离术
早期胃癌
术后出血
Endoscopic mucosal resection
Risk factors
Endoscopic submucosal dissection
Early gastric cancer
Postoperative bleeding
作者简介
通信作者:张澍田,Email:zhangshutian@ccmu.edu.cn.
