内镜下黏膜剥离术并发症及其危险因素分析

发布时间：2018-03-08 04:33

  本文选题：内镜下黏膜剥离术　切入点：术中穿孔　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨胃黏膜病变经内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)发生术中穿孔和术后出血情况,并分析相关危险因素。方法对2013年12月至2016年10月,于青岛大学附属医院因胃黏膜病变行内镜下黏膜剥离术患者的临床、内镜及病理资料进行核对记录。排除不符合纳入要求的患者资料,对符合纳入要求的患者手术相关资料进行统计,并分析以下相关因素:1.患者相关因素:性别、年龄、是否伴发高血压,糖尿病,及其他慢性病史(慢性肺炎、慢性肾病、肝硬化等)、既往是否服用抗凝药等。2.病变相关因素:病变直径、病变部位、病变数量、内镜下分型、表面伴有溃疡或瘢痕情况、是否合并幽门螺旋杆菌(Helicobacter Pylori,HP)感染及病理类型等。3.操作相关因素:手术时间、手术者经验、病变切除情况(整块或分块)、术中放置钛夹或缝合情况。采用SPSS19.0统计软件,对上述相关因素进行单因素及多因素分析,由此确定ESD术中穿孔及术后出血的相关危险因素。结果1.共有18例患者(含18处病变)发生ESD术中穿孔,均为微小穿孔,术中穿孔发生率为3.6%。2.病变位置、病变直径在穿孔组与未穿孔组两组之间差异有统计学意义(P0.05),进一步多因素Logistic回归分析显示,病变直径≥2 cm(OR值6.87,95%CI为1.66-28.44),病变位于贲门胃底(OR值18.31,95%CI为4.31-78.04)是术中穿孔的独立危险因素。3.患者性别、年龄、是否伴有合并症、既往服用抗凝药、是否伴有HP感染、是否伴有溃疡或瘢痕、病理类型、内镜下分型及是否整块切除等在在穿孔组与未穿孔组两组之间差异无统计学意义(P0.05)。4.共有12例患者(含12处病变)发生ESD术后出血,发生率为2.4%,所有发生出血或穿孔的患者均经内镜下保守治疗成功后出院,无死亡病例发生。5.病变直径在出血组与未出血组两组之间差异有统计学意义(P0.05),进一步多因素Logistic回归分析显示,病变直径≥4cm(OR值8.98,95%CI为1.59-50.53)是术后出血的独立危险因素。6.患者性别、年龄、是否伴有合并症、抗凝药物服用史、是否伴有HP感染、是否伴有溃疡或瘢痕、病理类型、内镜下分型、病变部位及是否整块切除等在出血组与未出血组两组之间差异无统计学意义(P0.05)。结论1.胃黏膜病变位于贲门胃底、直径≥2cm是ESD发生术中穿孔的独立危险因素。2.病变直径≥4cm是术后出血的独立危险因素。
[Abstract]:Objective to investigate the incidence of intraoperative perforation and postoperative bleeding in endoscopic submucosal dissection of gastric mucosal lesions, and to analyze the risk factors. The clinical, endoscopic and pathological data of patients undergoing endoscopic mucosal dissection due to gastric mucosal lesions in the affiliated Hospital of Qingdao University were checked and recorded. The data of patients who did not meet the requirements of inclusion were excluded. Analyze the following factors: sex, age, hypertension, diabetes, and other chronic diseases (chronic pneumonia, chronic nephropathy, and other chronic diseases), and analyze the following related factors: sex, age, hypertension, diabetes, and other chronic disease history (chronic pneumonia, chronic nephropathy, chronic pneumonia, chronic nephropathy, chronic pneumonia, chronic nephropathy). Liver cirrhosis, whether or not to take anticoagulants, etc. 2. Pathological changes related factors: lesion diameter, lesion location, number of lesions, endoscopic classification, surface with ulcer or scar, Whether Helicobacter pylori Helicobacter pylori (Helicobacter pylori) infection and pathological type, etc. 3. Operation related factors: time of operation, experience of operation, resection of lesion (whole or divided into pieces, placement of titanium clip or suture during operation). SPSS19.0 statistical software was used. Univariate and multivariate analysis was carried out to determine the risk factors for perforation during and after ESD. Results 1. There were 18 patients (including 18 lesions) with ESD perforation, all of which were microperforation. 2. The incidence of perforation during operation was 3.6%. The location of lesion and the diameter of lesion were significantly different between the perforation group and the non-perforation group (P 0.05). The further multivariate Logistic regression analysis showed that there was no significant difference between the two groups. The CI of lesion 鈮，

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