胃部病变内镜黏膜下剥离术后出血危险因素分析

Analysis of bleeding risk factors after ESD operation for gastric lesions

[目的]探讨内镜黏膜下剥离术(ESD)治疗胃部病变术后出血的危险因素。[方法]收集行胃ESD治疗的899例患者的临床资料,对病例的年龄、性别、病变直径、病变位置、手术持续时间、创面处理方式等进行单因素及多因素分析,总结术后出血的危险因素及发病时间规律,为术前及术中评估出血风险提供参考。[结果]899例患者中,20例(2.22%)出现术后出血,其中90%发生在术后5 d内。单因素χ;分析结果显示,男性的出血发生率高于女性,病变直径≥3 cm的出血发生率高于病变直径<3 cm的患者,不同病变位置及创面处理方式的出血发生率存在差异(P<0.05)。多因素Logistic回归分析结果显示,未使用止血夹(P=0.008,OR=4.487,95%CI:1.478~13.620)、病变直径≥3 cm(P=0.008,OR=3.376,95%CI:1.371~8.313)是胃ESD后出血的独立危险因素。[结论]未使用止血夹、病变直径≥3 cm的患者,胃部病变ESD后出血的发生率较高,术后5 d是发生出血的危险期。

[Objective]Explore risk factors for postoperative bleeding in endoscopic submucosal dissection(ESD)on gastric lesions.[Methods]Clinical data of 899 patients receiving ESD treatment in the Center of Gastroenterology Endoscopy, People’s Hospital of Wuhan University from January 2017 to December 2019 were collected.The age, gender, lesion diameter, lesion location, duration of surgery, and wound treatment were analyzed by single and multiple factors, and the risk factors of postoperative bleeding and the regularity of onset time were summarized.[Results]Among the 899 patients, 20(2.22%)experienced postoperative bleeding, 90% of which occurred within 5 days after surgery.Single-factor analysis showed that the incidence of bleeding in men was higher than that in women, the incidence of bleeding in patients with lesion diameter ≥ 3 cm was higher than that in patients with lesion diameter<3 cm, and the incidence of bleeding in patients with different lesion locations and wound treatment methods was different(P<0.05).Multivariate Logistic regression analysis showed that the non-use of hemostatic clips(P=0.008,OR=4.487,95%CI:1.478-13.620),lesion diameter ≥ 3 cm(P=0.008,OR=3.376,95%CI:1.371-8.313)were independent risk factors for bleeding after ESD.[Conclusion]Patients who did not use hemostatic clips and lesion diameter ≥ 3 cm have a higher incidence of bleeding after ESD surgery for gastric lesions, and 5 days after surgery is the risk period for bleeding.