内镜黏膜下剥离术治疗大肠隆起性病灶相关并发症危险因素分析

Analysis of Risk Factors of complications associated with endoscopic submucosal Dissection in the Treatment of colorectal Eminence Lesions

目的评价内镜黏膜下剥离术(ESD)治疗大肠隆起性病变的疗效及手术相关并发症的危险因素。方法回顾分析2015年1月至2018年7月南京医科大学第二附属医院消化内镜中心经内镜黏膜下剥离术治疗的105例大肠隆起性病变患者,观察手术相关并发症发生情况及其危险因素。结果105例大肠隆起性病变中,发生术中穿孔0例,术后迟发性穿孔2例(1.9%),术中出血25例(23.8%),迟发性出血病3例(2.9%),感染2例(1.9%),予以内科保守治疗或外科治疗处理后均恢复良好;病灶大小是内镜黏膜下剥离术治疗大肠隆起性病变相关的手术并发症的独立危险因素,病灶越大,出现出血、穿孔、感染等并发症概率越大。结论内镜黏膜下剥离术治疗大肠道隆起性病变治疗安全、有效、可行,但严格掌握适应证,有利于减少术后并发症,改善患者预后。

Objective To evaluate the efficacy and risk factors of endoscopic submucosal dissection(ESD)in the treatment of colorectal eminence lesions.Methods Retrospective analysis of 105 patients with protuberant lesions of large intestine were treated by endoscopic submucosal dissection in the center of digestive endoscopy of the Second Affiliated Hospital of Nanjing Medical University from January 2015 to July 2018,the incidence and risk factors of surgical complications were observed.Results Among the 105 patients,there were 0 perforation during operation,2 delayed perforation after operation(1.9%),25 bleeding during operation(23.8%),3 delayed hemorrhage(2.9%)and 2 infection(1.9%),the patients recovered well after medical conservative treatment or surgical treatment;the size of the lesion is an independent risk factor for operative complications associated with endoscopic submucosal dissection for colorectal eminence lesions,and the larger the lesion,the higher the probability of bleeding,perforation,infection and other complications.Conclusion Endoscopic submucosal dissection is safe,effective and feasible in the treatment of large intestinal eminence lesions,but strict control of indications is helpful to reduce postoperative complications and improve the prognosis.