内镜黏膜下剥离术治疗上消化道早癌及癌前病变并发术中出血危险因素分析

Analysis of risk factors of intraoperative bleeding during endoscopic submucosal dissection for early cancer and precancerous lesions of upper gastrointestinal tract

目的观察内镜黏膜下剥离术（ESD）治疗上消化道早癌及癌变病变并发术中出血情况,并分析其危险因素。方法回顾分析2012-01～2015-12于延安大学咸阳医院实施ESD治疗的113例患者的临床资料,对ESD术中并发出血的危险因素进行Logistic回归分析。结果纳入研究的113例患者有32例（28.32%）发生ESD术中出血,均采用电凝或止血夹治疗。对ESD术中出血的相关因素进行Logistic回归分析结果表明,使用抗血栓药物〉1年、病变位于贲门-胃底、病变〉5 cm、操作时间〉90 min、病理为早癌与ESD术中出血显著相关（P〈0.05）。结论 ESD并发术中出血的风险受患者本身情况、病变特点以及手术时间等多种因素的共同影响,全面综合的分析准备能对安全有效实施ESD治疗策略提供帮助。

Objective To investigate the incidence of intraoperative bleeding during endoscopic submucosal dissection（ ESD） for early cancer and precancerous lesions of upper gastrointestinal tract and analyze its risk factors. Methods The clinical data of 113 patients undergoing ESD in Xianyang Hospital of Yan＇an University from January 2012 to December 2015 were retrospectively analyzed. The risk factors of intraoperative bleeding were analyzed by Logistic regression analysis. Results The intraoperative bleeding occurred in32 patients（ 28. 32%） and they were treated by electric coagulation or titanium clip. Logistic regression analysis showed that the use of antithrombotic drugs 1 year,the lesions located at cardia-fundus of stomach,diameter of lesion 5 cm,operative time 90 min and early cancer were significantly related with ESD intraoperative hemorrhage（ P〈0. 05）. Conclusion The intraoperative bleeding during ESD is affected by patient＇s condition,feature of,the operation time and so on. The comprehensive analysis is helpful to implement the safe and effective treatment strategy of ESD.