内镜黏膜下剥离术治疗胃间质瘤出现并发症的可能危险因素分析

Analysis of risk factors for complications in endoscopic submucosal dissection treatment of gastric stromal tumors

[目的]分析胃间质瘤的临床特征及采用内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗时出现并发症的情况,并分析出现并发症的可能危险因素。[方法]回顾性分析行ESD治疗且病理确诊为胃间质瘤的108例患者的临床资料,分析患者的临床特征、治疗情况以及并发症情况。[结果]108例中共发现胃间质瘤111个,一次完整切除率98.2%(109/111),其中11例发生术中出血,10例发生术中穿孔,5例发生术后迟发性出血,1例出现术后穿孔,13例出现术后感染,1例术后追加外科手术。单因素分析显示,ESD治疗胃间质瘤发生术中穿孔与患者不同基础疾病比较差异有统计学意义(P=0.001);发生术后迟发性出血与病灶部位不同差异有统计学意义(P=0.009);发生术后感染与瘤体大小(P=0.001)及不同基础疾病(P=0.006)比较差异有统计学意义。多因素分析显示,合并基础疾病是发生术后感染的独立危险因素(P=0.025)。[结论]ESD治疗胃间质瘤时,患有糖尿病的患者易发生术中穿孔,瘤体位于胃底体交界处的患者易发生术后迟发性出血,对于瘤体直径在1.1~2.0 cm、患有糖尿病的患者,易发生术后感染;合并基础疾病是发生术后感染的独立危险因素。

[Objective]To analyze the clinic features of gastric stromal tumors(GST)and to explore the possible risk factors of complications after endoscopic submucosal dissection(ESD)treatment.[Methods]Data of 108 patients diagnosed GST and treated by ESD in the First Affiliated Hospital of Zhengzhou University were reviewed.The clinic characteristics,treatment and complications were analyzed.[Results]Total of 111 tumors were found in 108 patients.The complete resection rate was 98.2%(109/111),11 patients suffering intraoperative active bleeding,10 patients suffering intraoperative perforation,5 patients suffering delayed bleeding,1 patients suffering postoperative perforation,13 patients suffering postoperative infection.One patient received additional surgical treatment.The single factor analysis showed that there was significant difference in the different basic diseases(P=0.001)in the ESD treatment of GST when the intraoperative perforation occurred.There was significant difference in the lesion location(P=0.009)during the ESD treatment of GST when the delayed postoperative hemorrhage occurred.There was significant difference in the size of tumor(P=0.001)and the different basic diseases(P=0.006)in the ESD treatment of GST when the postoperative infection occurred.The multivariate analysis showed that combined with basic diseases was an independent risk factor for postoperative infection(P=0.025).[Conclusion]During ESD treatment of GST,patients with diabetes mellitus may be prone to intraoperative perforation,patients with tumors located at the gastric fundus-body junction may be prone to delayed postoperative hemorrhage,and patients with tumors diameters from 1.1 to 2.0 cm and diabetes mellitus may be prone to postoperative infection.Combined with basic diseases was the independent risk factor for postoperative infection.