内镜黏膜下剥离术治疗早期胃癌及癌前病变效果及继发出血独立危险因素探讨

Clinical effects and independent risk factors for secondary bleeding in patients with early gastric cancer and precancerous lesions treated with endoscopic submucosal dissection

[目的]探讨早期胃癌及癌前病变行内镜黏膜下剥离术(ESD)治疗效果及继发出血独立危险因素,为后续临床防治工作提供参考。[方法]回顾性分析我院2015-01-2017-12期间行ESD治疗的早期胃癌及癌前病变患者共122例临床资料,记录临床疗效及继发出血情况;采用χ~2检验和Logistic多因素回归模型分析继发出血独立危险因素。[结果]122例患者均顺利完成ESD,整块切除率达100.00%(122/122),治愈性切除率为91.80%(112/122);手术用时27~132(76.50±10.78)min;ESD继发出血共22例,发生率为18.03%,未见穿孔发生。单因素分析结果显示,病变部位、操作时间及术后病理类型与早期胃癌及癌前病变患者ESD继发出血有关(P<0.05);Logistic多因素回归分析显示,贲门-胃底部病变、早期胃癌及操作时间过长是导致患者继发出血独立危险因素(P<0.05)。[结论]早期胃癌及癌前病变行ESD治疗效果及安全性良好;其中贲门-胃底部病变、早期胃癌及操作时间≥60min患者继发出血风险更高。

[Objective]To investigate the clinical effects and independent risk factors for secondary bleeding in patients with early gastric cancer and precancerous lesions treated with endoscopic submucosal dissection(ESD).[Methods]Clinical data of 122 patients with early gastric cancer and precancerous lesions treated with ESD were retrospectively chosen in the period from January 2015 to December 2017 and clinical efficacy and complications after operation were recorded;the independent risk factors for secondary bleeding were analyzed by χ~2 test and Logistic regression model.[Results]All patients were successfully treated by ESD.The total resection rate and cure resection rate were 100.00%(122/122),91.80%(112/122)respectively;the operation time range were 27-132 minutes and average operation time were(76.50±10.78)min,and the secondary bleeding occurred in 22 cases(18.03%)without perforation occurred.Univariate analysis showed that lesion location and pathological type were related to secondary bleeding after ESD(P<0.05).Logistic multivariate regression analysis showed that cardia-gastric fundus lesions and early gastric cancer were independent risk factors of secondary bleeding after ESD(P<0.05).[Conclusion]ESD is safe and effective in the treatment of patients with early gastric cancer and precancerous lesions.Patients with cardia-gastric fundus lesions and early gastric cancer possess the higher risk of secondary bleeding after operation.