内镜黏膜下剥离术治疗胃肠道间质瘤术中穿孔的危险因素分析

Analysis of risk factors of perforation in endoscopic submucosal dissection for gastrointestinal stromal tumors

目的探讨内镜黏膜下剥离术治疗胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的有效性及其并发症的危险因素。方法回顾性分析2014年12月至2016年12月在绍兴市人民医院行内镜黏膜下剥离术(endoscop-ic submucosal dissection,ESD)的60例GIST患者的临床资料,记录性别、年龄、病变直径、部位等术前检查资料,以及手术时间、出血量、术中并发症,分析穿孔并发症的危险因素。结果术中无大出血发生,平均出血量(36.6±10.5)ml。10例(16.7%)发生术中穿孔,穿孔直径平均(0.7±0.5)cm,其中有6例病变直径1~2 cm,4例病变直径≥2 cm;病灶位于胃底8例、胃体1例、食管1例;7例肿瘤浸润至深固有肌层,3例为浅固有肌层。单因素分析结果显示,穿孔组和未穿孔组的出血量、手术时间、病灶直径、病灶部位和浸润深度差异均有统计学意义(P<0.05)。结论 ESD是GIST的可靠治疗方法,穿孔发生率较低,肿瘤大小、位置、浸润深度是术中穿孔的危险因素。

Objective To evaluate the value of endoscopic submucosal dissection （ESD） for treatment of gastrointestinal stromal tumor （GIST） and clinical risk factors of complications. Methods The clinical data of 60 patients with GIST from December 2014 to December 2016 in Shaoxing People＇s Hospital for ESD were retrospectively analyzed. The data of the preoperative examination, such as gender, age, lesion diameter and location, as well as the operation time, bleeding volume and intraoperative complications were recorded, and the risk factors for the complications of perforation were analyzed. Results No serious bleeding occurred during the operation. The average bleeding volume during operation was （36.6±10.5）ml. Perforation occurred in 10 patients （16.7%）, with the perforation diameter of （0.7±0.5）cm. In the 10 perforation patients, lesion diameter of 6 cases was 1-2 cm, 4 cases≥2 cm. Lesion located in gastric fundus in 8 cases, gastric body in 1 case, esophagus in 1 case. Lesion origined from deep muscularis propria in 7 cases, shallow muscularis propria in 3 cases. Univariate analysis results showed significantly difference in bleeding volume, operation time, lesion diameter, lesion position and invasion depth between the perforation and non-perforation group （P 〈 0.05）. Conclusion ESD is a reliable technology with low perforation rate in GIST treatment. The diameter, position and invasion depth of lesions are the risk factors of perforation during ESD operation.