内镜下胃黏膜剥离术后溃疡愈合影响因素分析

目的探讨胃黏膜病变经内镜下黏膜剥离术(ESD)后影响溃疡愈合的危险因素.方法回顾性分析2015年11月至2018年10月因胃黏膜病变行胃ESD患者的临床资料,应用logistic回归统计分析相关因素:(1)患者因素:性别,年龄,是否有高血压、糖尿病、其他慢性病等既往病史,是否有手术史、吸烟、饮酒史,幽门螺杆菌(Hp)感染等;(2)病变因素:病变大小,病变部位,病变形态、病理类型.结果纳入病例152例,有11例患者ESD术后复查胃镜提示溃疡未愈合.通过logistic回归分析发现,ESD术后溃疡未愈合主要与Hp感染相关.3例患者有2次早期胃癌ESD手术病史,且2次手术间隔>1年,并均有Hp感染,但由于病例数偏少,未能进一步统计分析.结论Hp感染是影响胃ESD术后溃疡愈合的危险因素,而术后未及时根除Hp或Hp根除后再感染可能是导致ESD术后异时性胃癌发生的可能原因.

Objective To investigate the risk factors of ulcer healing after endoscopic submucosal dissection(ESD)in gastric mucosal lesions.Methods Retrospective analysis of data from patients with ESD due to gastric mucosal lesions from November 2015 to October 2018.Logistic regression analysis was used to analyze the following relevant factors:①Patient factors:gender,age,hypertension,diabetes,other chronic diseases and surgical history,smoking history,drinking history,Helicobacter pylori infection;②Lesion factors:lesion size,location,morphology,pathological type.Results A total of 152 patients were reviewed.There were 11 patients who underwent a gastroscopy after ESD to suggest that the ulcer did not heal.Logistic regression analysis found that unhealed ulcers after ESD were mainly associated with Hp infection.In addition,we found that there were three patients have a history of early gastric cancer ESD twice,and the interval between the two operations was more than one year.And they all had infect Hp.Due to the small sample size,no further statistical analysis was performed.Conclusion Hp infection is a risk factor for ulcer healing after gastric ESD.Reinfection or failure to eradicate Hp in time may be a possible cause of metachronous gastric carcinoma after ESD.