早期胃癌及其癌前病变患者EMR术后出血发生情况及影响因素

Analysis of the Influencing Factors and Postoperative Bleeding after EMR in Patients with Early Gastric Cancer and Its Precancerous Lesions

目的:观察早期胃癌(EGC)及其癌前病变患者内镜黏膜切除术(EMR)术后出血发生情况,并分析相关影响因素。方法:回顾性分析2019年10月至2020年7月河南科技大学第一附属医院收治的166例行EMR的EGC及其癌前病变患者临床资料,根据是否发生术后出血分为出血组9例和未出血组157例,采用logistic回归分析影响患者术后出血的因素。结果:166例患者中有9例发生术后出血,发生率为5.42%;出血组患者主要病变部位、病变直径、病变数目、浸润深度和主刀医生年资与未出血组患者比较,差异具有统计学意义(P<0.05);两组患者的年龄、性别、糖尿病病史、高血压病史、高脂血症病史、肿瘤家族史、吸烟史、饮酒史、阿司匹林服药史、氯吡格雷服药史、二甲双胍长期服药史、病理类型、水平切缘、垂直切缘及操作时间比较,差异均无统计学意义(P>0.05);多因素logistic回归分析结果显示,患者主要病变部位位于贲门-胃底部[OR=8.240,95%CI(2.871,23.653)]、病变数目≥2个[OR=1.692,95%CI(2.252,13.093)]、病变直径≥2 cm[OR=6.713,95%CI(2.667,16.897)]、浸润深度达黏膜下层[OR=4.067,95%CI(1.671,9.903)]及主刀医生年资<5年[OR=3.908,95%CI(2.031,9.521)]均为导致EMR术后出血的独立危险因素。结论:患者主要病变部位位于贲门-胃底部、病变数目≥2个、病变直径≥2 cm、浸润深度达黏膜下层和主刀医生年资<5年是导致EGC及其癌前病变患者EMR术后出血的独立危险因素,应重视具备这类影响因素的患者,做好术前评估,必要时采取相应措施以降低患者出血风险,保障患者安全。

Objective To observe and analyze the postoperative bleeding of patients with early gastric cancer(EGC)and precancerous lesions after endoscopic mucosal resection(EMR),and analyze the related influencing factors.Methods The clinical data of 166 patients with EGC and its precancerous lesions with EMR in the First Affiliated Hospital of Henan University of Science and Technology from October 2019 to July 2020 were retrospectively analyzed.According to the occurrence of postoperative bleeding,they were divided into 9 cases in the bleeding group and 157 cases in the non-bleeding group,and the factors influencing postoperative bleeding were analyzed by logistic regression.Results Postoperative bleeding occurred in 9 of the 166 patients,with an incidence rate of 5.42%;There were statistically significant differences between the bleeding group and the non-bleeding group in the main lesion site,lesion diameter,number of lesions,infiltration depth and seniority of the chief surgeon in the bleeding group were significantly different from those in the non-bleeding group(P<0.05).There was no statistically significant difference between the two groups in patient's age,gender,history of diabetes,hypertension,hyperlipidemia,medical history,family history of cancer,smoking history,drinking history,history of medicine,clopidogrel aspirin dose,metformin long-term medication history,pathological type,horizontal vertical cutting edge and cutting edge,operation time(P>0.05);Multivariate logistic regression analysis showed that the main lesions were located in cardia to fundus of the stomach[OR=8.240,95%CI(2.871,23.653)]and the number of lesions was≥2[OR=1.692,95%CI(2.252,13.093)],lesion diameter≥2 cm[OR=6.713,95%CI(2.667,16.897)],infiltration depth to submucosa[OR=4.067,95%CI(1.671,9.903)]and the operating surgeon's experience<5 years[OR=3.908,95%CI(2.031,9.521)]were independent risk factors for bleeding after EMR.Conclusion The main lesion site in patients from cardia to fundus of the stomach,the number of lesions≥2,the diameter of lesions≥2 cm,the infiltration depth to submucosa and the experience of the surgeon<5 years are independent risk factors for postoperative bleeding in Patients with EGC and precancerous lesions.Attention should be paid to patients with such influencing factors and preoperative evaluation should be made.Appropriate measures should be taken when necessary to reduce the risk of bleeding and ensure patient safety.