消化道早期癌内镜黏膜下剥离术后出血的危险因素研究

Study of Risk Factors for Bleeding after Endoscopic Submucosal Dissection for Early Gastrointestinal Cancer

目的 探讨消化道早期癌内镜黏膜下剥离术后出血的危险因素。方法 选取2019年1月—2021年1月聊城市传染病医院收治的109例消化道早期癌患者作为研究对象,所有患者均开展内镜黏膜下剥离术治疗,术后密切观察其生命体征,将术后24 h~30 d内发生出血现象与未发生出血患者的人口学资料和临床特征进行比较,采用Logistic回归方程分析影响消化道早期癌内镜黏膜下剥离术后出血的危险因素。结果 109例患者中11例发生术后出血纳入出血组,占10.09%,其中6例出血发生于术后1周内,3例发生于术后第10天,2例发生于术后第12天。余下98例术后正常恢复者纳入无出血组,占89.91%。经单因素分析显示,两组在合并症(高血压)、手术操作时间、氯吡格雷服药史、病灶数量、病变直径方面差异有统计学意义(P<0.05),将有差异资料带入Logistic回归方程计算,发现高血压、手术操作时间、氯吡格雷服药史、病灶数量、病变直径方面均是影响消化道早期癌ESD术后出血的危险因素(OR>1,P<0.05)。结论 高血压、手术操作时间、氯吡格雷服药史、病灶数量、病变直径等因素均会对内镜下黏膜剥离术造成影响,也是导致术后出血的独立危险因素,在患者临床治疗过程中需针对性地加强对上述危险因素的干预与预防,以减少术后出血概率,从而保障患者生命安全,改善患者预后情况。

Objective To investigate the risk factors of bleeding after endoscopic submucosal dissection for early gastrointestinal cancer.Methods 109 patients with early gastrointestinal cancer admitted to Liaocheng Infectious Disease Hospital from January 2019 to January 2021 were selected as the study subjects,all patients were treated with endoscopic submucosal dissection,and their vital signs were closely observed after surgery.Demographic data and clinical characteristics of patients who experienced bleeding within 24 h to 30 d after surgery were compared with those who did not.Logistic regression equation was used to analyze the risk factors affecting bleeding after endoscopic submucosal dissection for early gastrointestinal cancer.Results Eleven of a total of 109 patients(10.09%)who experienced postoperative bleeding were included in the bleeding group.Among them,6 cases of bleeding occurred within 1 week after surgery,3 cases occurred on the 10th day after surgery,and 2 cases occurred on the 12th day after surgery.The remaining ninety-eight cases with normal postoperative recovery were included in the no bleeding group,accounting for 89.91%.Univariate analysis showed that there were statistically significant differences between the two groups in terms of complications(hypertension),operation time,clopidogrel medication history,number of lesions and diameter of lesions(P<0.05).The Logistic regression equation showed that hypertension,operative time,clopidogrel dosing history,number of lesions,and lesion diameter were the risk factors for bleeding after ESD for early gastrointestinal cancer(OR>1,P<0.05).Conclusion Hypertension,operative time,clopidogrel medication history,number of lesions,and lesion diameter are all factors that affect endoscopic mucosal dissection.It is also an independent risk factor for postoperative bleeding.Targeted intervention and prevention of the above risk factors should be strengthened during clinical treatment to reduce the chance of postoperative bleeding,so as to protect patients'life safety and improve their prognosis.