内镜黏膜下剥离术与内镜下黏膜切除术治疗早期胃癌的效果及术后出血的影响因素分析

Analysis of influencing factors of endoscopic submucosal dissection and mucosal resection for early gastric cancer and postoperative bleeding

目的比较内镜黏膜下剥离术(ESD)与内镜下黏膜切除术(EMR)治疗早期胃癌的效果,分析两种手术后出血的影响因素。方法选取2017年8月至2019年5月首都医科大学附属北京天坛医院收治的92例早期胃癌患者,按治疗方法的不同将其分为ESD组(52例)与EMR组(40例),比较两组治疗效果及术中、术后并发症发生情况;按术后出血情况,将本组92例患者分为出血组(8例)与未出血组(84例),比较两组的临床资料,采用多因素Logistic回归分析术后出血的危险因素。结果两组患者均顺利完成手术。ESD组的完整切除率高于EMR组(90.4%vs. 70.0%),治愈性切除率高于EMR组(76.9%vs. 55.0%),差异有统计学意义(P<0.05)。ESD组的手术时长及切除病灶直径大于EMR组,差异有统计学意义(P<0.05);ESD组的术后出血发生率与EMR组比较差异无统计学意义(9.6%vs. 7.5%,P>0.05),术中穿孔发生率两组比较差异无统计学意义(P>0.05);与未出血组比较,出血组患者长期使用抗凝药史比例高,病灶直径大,手术时间长,病灶位置为胃上1/3的比例高(P<0.05)。多因素Logistic分析结果显示,长期使用抗凝药物、病灶直径大、病灶位置为胃上1/3及手术时间长是影响早期胃癌患者术后出血的危险因素(P<0.05)。结论 ESD治疗早期胃癌的病灶切除率高于EMR,长期使用抗凝药物、手术时间过长、胃上1/3部位病变及病变直径大于4 cm是早期胃癌患者行ESD或EMR术后出血的危险因素。

Objective The effects of endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) in the treatment of early gastric cancer were compared, and the influencing factors of postoperative bleeding were analyzed. Methods A total of 92 patients with early gastric cancer admitted to Beijing Tiantan Hospital, Capital Medical University from August 2017 to May 2019 were selected and divided into ESD group(52 cases) and EMR group(40 cases) according to different treatment methods. The treatment effect and the incidence of intraoperative or postoperative complications in the two groups were compared. According to the postoperative bleeding, the 92 patients in this group were divided into the bleeding group(8 cases) and the non-bleeding group(84 cases). The clinicopathological data of the two groups were compared, and the risk factors of postoperative bleeding in patients with early gastric cancer were analyzed by multivariate Logistic regression. Results The operation was completed successfully in both groups. The intact resection rate of ESD group was higher than that of EMR group(90.4% vs. 70.0%), and the curative resection rate of ESD group was higher than that of EMR group(76.9% vs. 55.0%), with statistical significance(P<0.05). The operative time and diameter of excised lesions in ESD group were longer than those in EMR group, and the differences were statistically significant(P<0.05). There was no significant difference in the incidence of postoperative bleeding between the ESD group and the EMR group(9.6% vs. 7.5%, P>0.05). There was no significant difference in the incidence of intraoperative perforation between the ESD group and the EMR group(5.8% vs. 0, P>0.05). Compared with the non-bleeding group, the bleeding group had a higher proportion of long-term anticoagulant application history, larger lesion diameter, longer operation time, and higher proportion of lesions located in the upper 1/3 of the stomach and the middle 1/3 of the stomach, with statistical significance(P<0.05). Multivariate Logistic analysis showed that long-term use of anticoagulant drugs, large lesion diameter, lesion location in the upper 1/3 of the stomach and long operation time were the risk factors affecting postoperative bleeding in patients with early gastric cancer(P<0.05). Conclusions In patients with early gastric cancer, ESD resection rate is better than EMR. Preoperative use of anticoagulants, long operation time, lesions in the upper 1/3 of the stomach and lesions with a diameter of more than 4 cm are the risk factors for postoperative bleeding in patients with early gastric cancer.