内镜黏膜下剥离术治疗早期结直肠癌及癌前病变术后迟发性出血的危险因素分析

Risk factors of delayed bleeding after endoscopic submucosal dissection for early colorectal cancer and precancerous lesions

目的探讨内镜黏膜下剥离术(ESD)治疗早期结直肠癌及癌前病变术后迟发性出血的可能危险因素。方法收集2012年10月至2016年10月湖北省肿瘤医院内镜科采用ESD治疗的138例早期结直肠癌及癌前病变的临床资料,分别采用单因素分析及多因素非条件Logistic回归分析探讨引起迟发性出血的危险因素。结果 ESD治疗的138例早期结直肠癌及癌前病变患者中,10例发生迟发性出血,发生率为7.2%。卡方检验发现,发生迟发性出血组和未发生迟发性出血组在病灶位置(P=0.022)、病灶黏膜下层纤维化(P=0.016)、术中有无明显出血(P=0.032)及是否熟练手术者(P=0.045)方面差异均有统计学意义。以上四个危险因素经多因素非条件Logistic回归分析后发现,病灶位于直肠(P=0.003,OR=4.64,95%CI:1.71~12.58)及病灶黏膜下层重度纤维化(P=0.009,OR=4.83,95%CI:1.49~15.60)是早期结直肠癌及癌前病变ESD术后发生延迟性出血的独立危险因素。结论病灶位于直肠及病灶黏膜下层重度纤维化的早期结直肠癌及癌前病变患者ESD术后易发生迟发性出血。

Objective To investgate risk factors of delayed bleeding after endoscopic submucosal dissec-tion（ESD）for early colorectal tumor and precancerrous lesions. Methods We retrospectively reviewed clinicaldate of 138 patients with early colorectal tumor and precancerrous lesions who received ESD in Hubei Cancer Hos-pital from October 2012 to October 2016. Risk factors of delayed bleeding were analysed by univariate and multi-variable logistic regression analysis. Results Ten（7.2%）of 138 patients occurred delayed bleeding after ESD.Univariate analysis showed that there was significent difference between the bleeding group and the non-bleedinggroup in location of the lesion（P = 0.022）,severe fibrosis of submucosa（P = 0.016）,Obvious intraoperativebleeding（P = 0.032）and inadequate endosopic experience of endoscopist（P = 0.045）. Multivariate Logistic re-gression analysis showed that location of lesion（P = 0.003,OR = 4.64,95%CI：1.71-12.58）,severe fibrosis ofsubmucosa（P = 0.009,OR = 4.83,95%CI：1.49-15.60）were independent risk factors of delayed bleeding afterESD for early colorectal tumor and precancerrous lesions. Conclusion Patients with early colorectal tumor andprecancerrous lesions in the rectum and severe fibrosis of submucosa are prone to delayed bleeding after ESD.