内镜下黏膜剥离术后并发症危险因素分析

Analysis of the risk factors of postoperative complications after endoscopic submucosal dissection

目的 探讨内镜下黏膜剥离术（ESD）后发生迟发性出血、穿孔和消化道狭窄等并发症的危险因素.方法 回顾性分析本院消化外科于2011年1月至2014年12月行ESD的793例消化道病变患者的完整资料,将所有患者分别分为迟发性出血组（n=67）和非出血组（n=726）、穿孔组（n=47）和未穿孔组（n =746）以及消化道狭窄组（n=38）和非狭窄组（n=755）,采用单因素分析和Logistic多因素回归分析对患者临床基础资料、病变相关资料、手术相关资料等进行独立危险因素分析.结果 在行ESD的患者中,迟发性出血、穿孔和消化道狭窄的发生率分别为8.45％、5.93％和4.79％.单因素分析显示：迟发性出血的危险因素为长期服用抗凝药物、胃窦发生病变、病变直径≥5 mm以及病变分次切除;术后穿孔的危险因素为病变直径≥5 mm以及手术时间≥90 min;消化道狭窄的危险因素为食管发生病变、病变直径≥5 mm以及病变深度至固有肌层.多因素Logistic回归分析表明：迟发性出血危险因素的危险度排序为胃窦发生病变＞病变分次切除＞长期服用抗凝药物＞病变直径（≥5 mm）;穿孔危险因素的危险度排序为手术时间（≥90 mm）＞病变直径（≥5 mm）;消化道狭窄危险因素的危险度排序为食管发生病变＞病变直径（≥5 mm）＞病变深度至固有肌层.结论 行ESD的患者长期服用抗凝药物、胃窦病变以及分次切除病变的应注意迟发性出血,手术时间较长易发生术后穿孔,而对于食管病变和病变较深的患者尤其应该注意消化道狭窄.

Objective To investigate the risk factors of postoperative complications of delayed hemorrhage,perforation and digestive tract stenosis after endoscopic submucosal dissection （ESD）.Methods The complete data of 793 patients with digestive tract disease who underwent the endoscopic submucosal dissection in the Department of Digestive Surgery in our hospital from January 2011 to December 2014 were retrospectively analyzed.All of the patients were divided into delayed hemorrhage group （n =67） and nonbleeding group （n =726）;perforation group （n =47） and non-perforation group （n =746）;and digestive tract stenosis group （n =38） and non-stenosis group （n =755）.The clinical basic data,lesion related data,and operation related data were independent risk factor and analyzed by single factor analysis and Logistic multiple factor regression analysis.Results The incidence of delayed bleeding,perforation and stenosis in patients with ESD were 8.45%,5.93%,and 4.79%,respectively.The results of single factor analysis：the risk factors for delayed bleeding were long-term use of anticoagulant drugs,gastric sinus disease,lesion diameter,and lesion excision （P 〈 0.05）.The risk factors for postoperative perforation were the diameter of the lesion and the time of operation （P 〈 0.05）.The risk factors of digestive tract stenosis were the esophageal lesions,the diameter of the lesion,and the depth of the lesion to the intrinsic muscle layer （P 〈 0.05）.The results of multi factor Logistic regression analysis：the risk ranking of risk factors for delayed bleeding was gastric antrum occurrence lesion 〉 lesions graded resection 〉 long-term use of anticoagulants 〉 lesion diameter （≥5 mm）.The risk ranking of risk factors for perforation was operation time （≥90 mm） 〉 lesion diameter （≥5 mm）.The risk ranking of risk factors for digestive tract stenosis was esophageal lesion 〉 lesion diameter （≥ 5 mm） 〉 lesions depth to the muscularis propria.Conclusions For long-term anticoagulation,gastric antrum and fractional resection lesions of patients should pay attention to delayed bleeding.Patients with long operation time are easy to cause postoperative perforation.For long-term anticoagulation,gastric antrum and fractional resection lesions of patients should pay attention to delayed bleeding.