内镜黏膜下剥离术治疗胃黏膜下肿瘤的并发症与安全性分析

Complications and Safety of Endoscopic Submucosal Dissection for Gastric Submucosal Tumor

目的分析内镜黏膜下剥离术(ESD)治疗胃黏膜下肿瘤(GSMT)的并发症与安全性,并探讨并发症的相关危险因素。方法对101例ESD治疗的胃黏膜下肿瘤患者的临床资料进行回顾性分析,观察其并发症发生与处理情况;对术中并发出血、穿孔的危险因素行单因素卡方检验与多因素Logistic逐步回归分析。结果 101例患者的肿瘤均一次性完整切除,术中出血31例、穿孔8例,未发生延迟性出血及穿孔。术中出血、穿孔患者均保守治疗成功,未中转外科手术治疗。术中出血独立危险因素为:贲门-胃底、异位胰腺、肿瘤直径;术中穿孔的可能危险因素为:肿瘤直径、操作时间、病变深度、贲门-胃底。结论 ESD治疗胃黏膜下肿瘤并发症少,其并发症多可通过内镜下及其他内科手段成功治疗,是治疗胃黏膜下肿瘤安全可靠的方法。肿瘤位于贲门胃底、病理为异位胰腺、肿瘤直径较大的胃黏膜下肿瘤行ESD治疗发生术中出血风险较大;病变位于贲门-胃底、来源于固有肌层、直径较大、手术时间较长者发生穿孔的风险可能更大。

ABSTRACT:Objective To analyze the complications and safety of endoscopic submucosal dissec-tion (ESD)for gastric submucosal tumor (GSMT),and to investigate the risk factors for the complications.Methods Clinical data of 101 patients who underwent ESD for GSMT were ana-lyzed retrospectively.The complications and treatments of patients were investigated.Further-more,the risk factors for intraoperative hemorrhage and perforation were analyzed by univariate chi-square test and multivariate stepwise Logistic regression analysis.Results All patients under-went en bloc resection at the first treatment.Among the 101 patients,31 had intraoperative hem-orrhage and 8 had intraoperative perforation.No patients had delayed hemorrhage and perfora-tion.Patients with intraoperative hemorrhage and perforation underwent successful conservative treatment,and no patients were converted to surgical treatment.The cardia-fundus,ectopic pan-creas and tumor diameter were risk factors for intraoperative hemorrhage.The tumor diameter, operation time,lesion depth and cardia-fundus were risk factors for intraoperative perforation. Conclusion The ESD results in fewer complications in the treatment of GSMT,and most of the complications can be successfully treated by endoscopic therapy or other internal medicine proce-dures.Therefore,ESD is a safe and reliable treatment for GSMT.The cardia-fundus location,ec-topic pancreas,and larger tumor diameter are the high risk factors for intraoperative hemorrhage during ESD treatment for GSMT.The cardia-fundus location,source from intrinsic muscle layer, larger tumor diameter,and longer operation time are the high risk factors for intraoperative perfo-ration during ESD treatment for GSMT.