计算机视觉测量软件EAS法评估质子泵抑制剂联合黏膜保护剂对ESD术后溃疡愈合的影响

发布时间：2018-06-19 10:16

本文选题：内镜下粘膜剥离术 + ESD术后溃疡　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的随着内镜技术的不断发展,内镜下对病灶面积测量准确性的要求越来越高,本课题组与中国科学技术大学合作研制了一种新的内镜下病灶面积的测量方法——计算机视觉测量软件(EAS)。本研究拟采用EAS法测量早期胃癌(EGC)ESD术后内镜下溃疡面积与手术标本面积的大小,分析EAS法体内与体外测量面积的相关性,以验证计算机视觉测量软件测量内镜下病灶面积的可行性和准确性;另外,通过计算机视觉测量软件测量ESD术中、术后2周及术后4周溃疡面积大小的变化,以评价不同药物治疗方案对ESD术后溃疡愈合的影响,以期指导临床用药。方法1计算机视觉测量软件EAS法测量内镜下病灶面积可靠性分析收集2015年4月~2016年4月于安徽医科大学第一附属医院接受胃ESD术的癌前病变或早期胃癌患者。利用EAS法测量ESD术后内镜下溃疡面积及手术标本面积的大小,记录结果,采用合适的统计学方法分析其相关性。2 EAS法评估PPI联合黏膜保护剂对ESD术后溃疡愈合的影响接受胃ESD手术癌前病变或早期胃癌患者,排除术后追加手术或放疗患者,利用随机数字表法分为药物联合组和PPI组。药物联合组及PPI组均于术后三天给予艾司奥美拉唑40 mg Bid静脉滴注,术后第四天,药物联合组给予艾司奥美拉唑20 mg口服Bid×4周+替普瑞酮50mg口服Tid×4周;PPI组单独给予艾司奥美拉唑20 mg口服Bid×4周。两组患者术中及术后2周、4周进行胃镜检查同时EAS法测量溃疡面积,评价溃疡愈合情况及溃疡分期。结果1 EAS法测量内镜下病灶面积可靠性分析本试验共纳入ESD手术患者64例,利用EAS法所测ESD术后内镜下溃疡面积平均值为1510.50±484.22 mm2;术后标本面积平均值为961.28±356.99mm2。ESD术后溃疡面积明显大于手术标本面积,经统计学分析发现两者呈正相关,相关系数r=0.978,为显著性相关。2 EAS法评估PPI联合黏膜保护剂对ESD术后溃疡愈合的影响(1)一般情况将最终纳入本试验的64例患者随机分为药物联合组和PPI组,药物联合组33例,年龄48-78岁,平均年龄66.88±6.82岁,男:女1.75:1;PPI组31例,年龄46-79岁,平均年龄66.32±7.33岁,男:女1.38:1。药物联合组及PPI组患者均随访至术后4周,术中及术后均未追加手术或放疗。药物联合组及PPI组患者年龄、性别、病变性质、病变部位、创面大小均无统计学差异。(2)ESD术后迟发性出血及穿孔的发生情况药物联合组无迟发性出血,PPI组1例发生迟发性出血,内镜下成功止血,两组术后出血率无明显统计学差异(P=0.484)。两组均未见术中及术后穿孔情况。(3)ESD术后溃疡面积愈合情况术后2周,两组的溃疡面积均有明显缩小,经统计学分析,两组溃疡面积差异无统计学意义(P0.05),术后4周药物联合组溃疡面积显著小于PPI组,有统计学差异(P0.05)。(4)ESD术后溃疡分期的观察术后2周,药物联合组12例A1期,18例A2期,3例H1期;PPI组16例A1期,13例A2期,2例H1期,溃疡分期无统计学差异(P0.05)。术后4周,两组均以愈合期溃疡为主,药物联合组6例H1期,20例H2期,7例S1期;PPI组16例H1期,12例H2期,3例S1期,药物联合组溃疡愈合级别高于PPI组,有统计学差异(P0.05)。(5)ESD术后溃疡愈合的影响因素分析通过单因素分析,病变部位、病理类型及初始溃疡面积对ESD术后溃疡愈合有影响(P0.05)。通过进一步多因素逐步Logistic回归分析表明,初始溃疡面积及病变部位与ESD术后溃疡愈合显著相关(P0.01)。结论通过对ESD术后内镜下溃疡面积及手术标本面积的比较,结果显示两者呈正相关,相关系数r为0.978,为显著性相关。EAS法可用于测量体内病灶面积,具较好的可行性及准确性。ESD是治疗消化道癌前病变及早癌的可靠、有效的手段。ESD术后医源性溃疡面积较大,需要尽快促进溃疡愈合,预防出血、穿孔等并发症的发生。本研究采用不同药物治疗方案治疗ESD术后溃疡,观察ESD术后溃疡愈合速度及愈合质量,结果显示PPI联合黏膜保护剂疗法优于PPI单独疗法,提示PPI联合粘膜保护剂能更有效促进溃疡愈合,减少术后并发症的发生率。采用EAS法可以准确测量ESD术后溃疡面积,有利于对溃疡愈合情况的评估及药物治疗效果的客观评价。
[Abstract]:Objective with the continuous development of endoscopy, the requirement for the accuracy of focus area measurement is becoming more and more high. Our team and University of Science & Technology China have developed a new method of measuring the area of endoscopes - computer vision measurement software (EAS). This study is to use EAS to measure early gastric cancer (EGC) ESD The size of the area of the endoscopic ulcer area and the area of the surgical specimen was used to analyze the correlation between the EAS method and the measured area in vitro, in order to verify the feasibility and accuracy of the computer vision measurement software to measure the area of the lesion under endoscopy. In addition, the changes of the size of the ulcer area 2 weeks after the operation and 4 weeks after the operation were measured by the computer vision software. To evaluate the effect of different drug treatments on the healing of ulcer after ESD, to guide clinical medication. Method 1 computer vision software EAS method was used to measure the reliability of the lesion area under endoscopy in the First Affiliated Hospital of Medical University Of Anhui in April, April 2015, and to collect the precancerous lesions or early gastric cancer patients who received gastric ESD surgery in the First Affiliated Hospital of Medical University Of Anhui. EAS method was used to measure the area of endoscopy ulcers and the size of the area of the surgical specimen after ESD, and the results were recorded. A suitable statistical method was used to analyze the correlation.2 EAS method to evaluate the effect of PPI combined with mucosal protective agent on the healing of the ulcer after ESD, and to accept the precancerous or early gastric cancer patients in the gastric ESD operation, excluding the postoperative additional operation or radiotherapy. The drug combined group and the PPI group were given the intravenous drip of esomeprazole 40 mg Bid three days after the operation, and the drug combined group was given Bid x 4 weeks + tiprreone 50mg orally Tid for 4 weeks, and the group PPI group was given esomeprazole 20 mg mouth alone on the fourth day after the operation. Taking Bid for 4 weeks. Two groups of patients were performed intraoperative and 2 weeks, 4 weeks after 2 weeks, 4 weeks after gastroscopy, and EAS method was used to measure the area of ulcers. The results of the ulcer healing and the ulcer staging were evaluated. The results of the reliability analysis of the lesion area under the 1 EAS method were included in the 64 cases of the patients with ESD operation, and the mean value of the endoscopic ulcer area under the EAS method was 1510.5. 0 + 484.22 mm2; the average area of specimen area after operation was 961.28 + 356.99mm2.ESD and the area of the ulcer was obviously larger than the area of the surgical specimen. It was found that there was a positive correlation between them and the correlation coefficient r=0.978, which was a significant correlation.2 EAS method to evaluate the effect of PPI combined mucosal protective agent on the ulcer healing after ESD operation (1) the general situation would be finally included. 64 patients in this experiment were randomly divided into drug combination group and PPI group, 33 cases of drug combination group, age 48-78 years old, average age 66.88 + 6.82 years old, male: female 1.75:1; group PPI 31 cases, age 46-79 years, average age 66.32 + 7.33 years old, male: female 1.38:1. drug combination group and PPI group were followed up 4 weeks, both intraoperative and postoperative no additional operation or release. Treatment. There was no significant difference in age, sex, pathological nature, lesion location and size of wound in the combination group and PPI group. (2) late bleeding and perforation after ESD had no delayed bleeding, 1 cases in group PPI had delayed hemorrhage, and endoscopy was performed to stop bleeding, and there was no significant difference between the two groups after operation (P=0.48 4) there was no intraoperative and postoperative perforation in the two groups. (3) the ulcer area after ESD after operation was 2 weeks after operation, and the area of the ulcer area in the two groups was significantly reduced. The two groups of ulcer areas were not statistically significant (P0.05), and the ulcer surface of the combination group was significantly smaller than that in the group PPI after 4 weeks (P0.05). (4) the ulceration of ESD after operation. 2 weeks after surgery, 12 cases of A1, 18 A2, 3 H1, 16 A1, 13 A2, 2 H1 stages in group PPI were not statistically different (P0.05). In the two group, 4 weeks after operation, 6 cases of H1, 20 H2, S1 period, PPI group 16 cases, 12 cases The level of ulcer healing was higher than that of the PPI group (P0.05). (5) the influence factors of ulcer healing after ESD were analyzed by single factor analysis, the lesion site, pathological type and initial ulcer area had an influence on the healing of ulcers after ESD (P0.05). The initial ulcer area and lesion site were analyzed by step by step Logistic regression analysis. There was a significant correlation between the healing of ulcers after ESD (P0.01). Conclusion the results showed that there was a positive correlation between the area of endoscopic ulcers and the area of the surgical specimen after ESD. The correlation coefficient r was 0.978, and the significant correlation.EAS method could be used to measure the area of the lesion in the body, and it was a good and accurate.ESD for the treatment of the precancerous lesions of the digestive tract. Early cancer is reliable, effective means of.ESD postoperative iatrogenic ulcer area is larger. It is necessary to promote ulcer healing, prevent bleeding, perforation and other complications as soon as possible. This study uses different drug treatment regimens to treat the ulcer after ESD, and observe the healing speed and healing quality of the ulcer after ESD, and the results show that PPI combined with mucosal protective agent therapy is excellent. PPI alone therapy suggests that PPI combined with mucosal protective agents can promote the healing of ulcers and reduce the incidence of postoperative complications. The use of EAS can accurately measure the area of the ulcer after ESD, and is beneficial to the evaluation of the healing of ulcers and the objective evaluation of the effect of the drug treatment.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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