食管支架致上消化道大出血的危险因素

Risk factors of upper digestive tract massive bleeding caused by esophageal stent placement

目的探讨因恶性食管病变患者行支架置入术后发生大出血的危险因素及其相关性。方法 2005年1月至2011年6月因恶性食管狭窄或食管瘘行食管支架置入治疗患者,共235例,按是否16例发生致死性上消化道出血,分析患者在性别、肿瘤部位、支架类型、支架位置以及合并放疗、食管瘘、气管支架置入等因素的影响,并评价其相关性。结果 16例(6.8%)患者均表现为大量呕血,并均在短期内死亡。在有大出血患者中,食管瘘的导致大出血的主要原因,在年龄、性别、支架类型、支架位置及是否伴有气管支架、放疗因素差别均没有统计学意义。多变量回归分析提示食管瘘与术后大出血的发生有明显的相关性。结论食管瘘的存在是导致食管支架术后出现大出血的显著风险因素。

Objective To investigate the risk factors of upper digestive tract massive bleeding caused by esophageal stent placement for malignant diseases, and to analyze the correlation between the risk factors and the occurrence of bleeding. Methods A total of 235 patients with malignant esophageal stenosis or fistula, who were encountered in authors＂ hospital during the period from Jan. 2005 to June 2011, were enrolled in this study. Esophageal stent placement was performed in all patients. After the treatment, the patients were divided into bleeding group and non-bleeding group based on the occurrence of lethal massive bleeding of upper digestive tract. The age, gender, location of tumor, stent type, stent position, simultaneous use of radiotherapy, presence of esophageal fistula, tracheal stent placement, etc. were documented. The data were compared between the two groups, and their correlations were analyzed. Results Lethal hemorrhage occurred in 6.8% cases （16/235）, which presented as profuse hematemesis, and the patient died in a short period. The difference in the presence of esophageal fistula was statistically significant between the two groups, while no significant difference in other factors （age, gender, location of tumor, stent type, stent position, simultaneous use of radiotherapy, tracheal stent placement） existed between the two groups. Multivariate regression analysis indicated that a significant correlation existed between the presence of esophageal fistula and the occurrence of massive postoperative bleeding. Conclusion The presence of esophageal fistula is the most important risk factor causing upper digestive tract massive bleeding after esophageal stent placement.