胃早癌患者内镜下黏膜剥离术后二次内镜检查的临床影响

发布时间：2018-08-30 08:44

【摘要】：目的评价二次内镜是否能够预防内镜下黏膜剥离术(ESD)伴迟发性出血及确定何种病变需要二次内镜检查。方法共纳入2014年10月-2016年9月经组织学诊断的胃早癌患者98例,ESD术后24 h出现黏膜破损相关性出血认为是迟发性出血。回顾性研究患者病变及手术相关因素,行二次内镜检查前后的出血率。结果 98例患者整块切除率为100.0%,所有病灶切缘为阴性,无消化道穿孔及死亡严重并发症发生。ESD术后迟发性出血发生率5.1%(5/98),均已在二次内镜下成功止血,无1例手术、迟发性出血阴性者,随访无再出血发生。40.0%迟发性出血者(2/5)给予输血。ESD术后二次内镜检查的时间中位数是术后第2天(1~3 d),5例ESD术后迟发性出血患者出血时间中位数是术后第1天(1~10 d),手术持续时间中位数是75 min(60~150 min),预测成功率94.9%。单因素分析结果表明;年龄[(69.6±7.9)vs(60.9±10.1)岁,P=0.003],手术时间[(90.0±41.0)vs(66.0±42.0)min,P=0.000]是迟发性出血组和无出血组的2个危险因素。二元Logistic回归分析显示:手术时间(OR=1.07,95%CI:0.73~14.63,P=0.010)是ESD迟发性出血唯一预测因素。结论二次内镜检查预防胃ESD术后迟发性出血可能有效,尤其在ESD术后48 h内,操作时间是胃ESD术后迟发性出血的独立危险因素。
[Abstract]:Objective to evaluate whether secondary endoscopy can prevent (ESD) with delayed hemorrhage and determine which lesions need secondary endoscopy. Methods from October 2014 to September 2016, 98 patients with early gastric carcinoma were included in the study. The bleeding associated with mucosal breakage 24 hours after ESD was regarded as delayed hemorrhage. Retrospective study of patients with pathological changes and surgical related factors, secondary endoscopic examination before and after the bleeding rate. Results the total resection rate of 98 patients was 100.0.The margin of all the lesions was negative. The incidence of delayed bleeding after operation was 5.1% (5 / 98) without serious complications of digestive tract perforation and death. Those with delayed bleeding negative, The median time of second endoscopy in patients with delayed hemorrhage (2 / 5) was the second day (1 ~ 3 days) after ESD. The median time of bleeding in 5 patients with delayed hemorrhage after ESD was 1 day (1: 10 d),). The median operative duration was 75 min (60 / 150 min),) and the predictive success rate was 94. 9%. Univariate analysis showed that age [(69.6 卤7.9) vs (, 60.9 卤10.10) years old] and operative time [(90.0 卤41.0) vs (, 66.0 卤42.0) min,P=0.000] were two risk factors of delayed hemorrhage and no bleeding. Binary Logistic regression analysis showed that operative time (OR=1.07,95%CI:0.73~14.63,P=0.010) was the only predictor of delayed hemorrhage in ESD. Conclusion Secondary endoscopic examination may be effective in the prevention of delayed bleeding after gastric ESD, especially within 48 hours after ESD. Operation time is an independent risk factor for delayed bleeding after gastric ESD.
【作者单位】：山东省枣庄矿业集团中心医院消化内科;江苏省南京医科大学第二附属医院消化医学中心;安徽省宿州市立医院消化内科;山东大学齐鲁医院消化内科;
【分类号】：R735.2

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