内镜下黏膜剥离术中穿孔及其危险因素分析

PERFORATION DURING ENDOSCOPIC SUBMUCOSAL DISSECTION AND RELATED RISK FACTORS

目的探讨胃黏膜病变行内镜下黏膜剥离术(ESD)术中穿孔情况及其相关危险因素。方法回顾性分析我院2013年12月—2016年5月收治的488例因胃黏膜病变行ESD病人的临床资料,对以下相关因素进行术中穿孔危险因素的单因素分析及多因素Logistic回归分析。(1)病人相关因素:性别、年龄、伴发疾病、既往服用抗凝药情况;(2)病变相关因素:病变直径、部位、表面溃疡或瘢痕情况、幽门螺旋杆菌(HP)感染情况、内镜下分型、病理类型;(3)操作相关因素:是否整块切除。结果 488例病人(506处病变)中,18例(18处病变)发生ESD术中穿孔,发生率为3.6%;所有穿孔均经保守治疗成功。对ESD术中穿孔的单因素及多因素分析表明,病变位于贲门胃底(OR=18.31,95%CI=4.31~78.04,P<0.05)、病变直径≥2cm(OR=6.87,95%CI=1.66~28.44,P<0.05)与术中穿孔显著相关。结论病变位于贲门胃底、病变直径≥2cm是ESD术中穿孔的危险因素,对具有上述危险因素的病变,应警惕术中穿孔的发生,及时给予相应处理。

Objective To investigate perforation during endoscopic submucosal dissection（ESD）for gastric mucosal/submucosal lesions and related risk factors. Methods A retrospective analysis was performed for the clinical data of 488 patients who were admitted to our hospital due to gastric mucosal/submucosal lesions and underwent ESD from December 2013 to May2016.Univariate and multivariate logistic regression analyses were performed for the following risk factors for perforation during surgery：1.patient-related factors：sex,age,concomitant diseases,and history of anticoagulants;2.lesion-related factors：lesion diameter,location,ulcer or scar in the surface,Helicobacter pylori（HP）infection,endoscopic classification,and pathological type;3.procedure-related factors：en bloc resection or not. Results Of all patients（506lesions）,18（18lesions）experienced perforation during ESD,resulting in an incidence rate of 3.6%;all these patients were successfully cured with conservative treatment.The univariate and multivariate analyses revealed that the lesion located in the cardia and fundus ventriculi（OR=18.31,95%CI=4.31-78.04,P〈0.05）and lesion diameter≥2cm（OR= 6.87,95%CI=1.66-28.44,P〈0.05）were risk factors for perforation during ESD. Conclusion Lesions located in the cardia and fundus ventriculi and lesion diameter≥2cm are risk factors for perforation during ESD.Therefore,for lesions with these risk factors,we should look out for the occurrence of perforation during surgery and give treatment in a timely manner.