中国现代医学杂志2023，Vol.33Issue(24)：80-86,7.DOI:10.3969/j.issn.1005-8982.2023.24.014
消化道早癌患者内镜黏膜下剥离术后迟发性出血的危险因素分析
Risk factors for delayed bleeding after endoscopic submucosal dissection in patients with early cancer of the gastrointestinal tract
摘要
Abstract
Objective To analyze the risk factors for delayed bleeding after endoscopic submucosal dissection(ESD)in patients with early cancer of the gastrointestinal tract.Methods A total of 625 patients with early cancer of the gastrointestinal tract admitted to our hospital from May 2020 to February 2023,including 257 cases of gastric cancer and 368 cases of esophageal cancer,were retrospectively analyzed.All patients received ESD,and occurrence of delayed bleeding after ESD in patients with early cancer of the gastrointestinal tract was recorded.Patients with gastric cancer were divided into non-occurrence group A and occurrence group A according to whether delayed bleeding occurred after ESD,and patients with esophageal cancer were divided into non-occurrence group B and occurrence group B according to whether delayed bleeding occurred after ESD.The clinical data of the occurrence group A and the non-occurrence group A,as well as the occurrence group B and the non-occurrence group B,were compared.Factors affecting the occurrence of delayed bleeding after ESD were determined by multivariable Logistic regression analysis.Results Among 257 patients with gastric cancer,27 cases(10.51％)suffered from delayed hemorrhage after ESD.Of 368 patients with esophageal cancer,23 cases had delayed bleeding after ESD,with an incidence of 6.25％.Compared with the non-occurrence group A,the proportions of gastric body involvement,the lesion size≥20 mm,presence of large blood vessels within the submucosa,submucous fibrosis,operative duration ≥ 60 min,and long-term use of anticoagulant drugs were higher and the proportion of patients with the depth of tumor invasion limited to the mucosal layer was lower in the occurrence group A(P＜0.05).The multivariable Logistic regression analysis showed that presence of large blood vessels within the submucosa[(OR)=3.838(95％CI:1.687,8.731)],submucous fibrosis[(OR)=3.511(95％CI:1.544,7.988)],operative duration ≥ 60 min[(OR)=2.821(95％CI:1.240,6.417)]and long-term use of anticoagulant drugs[(OR)=4.415(95％CI:1.941,10.043)]were factors affecting the occurrence of delayed bleeding after ESD in patients with gastric cancer(P＜0.05).The proportions of patients with the depth of tumor invasion reaching the submucosal layer,the lesion size ≥40 mm,circumferential resection,presence of large blood vessels within the submucosa,submucous fibrosis,operative duration ≥ 60 min,and long-term use of anticoagulant drugs in the occurrence group B were higher than those in the non-occurrence group B(P＜0.05).Multivariable Logistic regression analysis revealed that presence of large blood vessels within the submucosa[(OR)=3.056(95％CI:1.343,6.951)],operative duration ≥ 60 min[(OR)=3.607(95％CI:1.586,8.206)],and long-term use of anticoagulant drugs[(OR)=4.104(95％CI:1.804,9.336)]were factors affecting the occurrence of delayed bleeding after ESD in patients with esophageal cancer(P＜0.05).Conclusions Among patients with early cancer of the gastrointestinal tract,those with large blood vessels within the submucosa,operative duration ≥ 60 min,and long-term use of anticoagulant drugs have a higher risk for delayed bleeding after ESD.关键词
消化道早癌/内镜黏膜下剥离术/迟发性出血/影响因素Key words
early cancer of the gastrointestinal tract/endoscopic submucosal dissection/delayed bleeding/influencing factor分类
医药卫生引用本文复制引用
刘荣泉,季云,张杰..消化道早癌患者内镜黏膜下剥离术后迟发性出血的危险因素分析[J].中国现代医学杂志,2023,33(24):80-86,7.基金项目
江苏省自然科学基金青年项目(No:BK20200052) （No:BK20200052）
