除菌后早期胃癌及癌前病变ESD后迟发性出血的影响因素

Influencing factors on delayed bleeding in early gastric cancer and precancerous lesions induced by ESD after Hp eradication

[目的]探讨除菌后早期胃癌及癌前病变内镜黏膜下剥离术(ESD)后迟发性出血(DPPB)的情况并分析其影响因素。[方法]回顾性分析397例除菌后早期胃癌及癌前病变ESD治疗的患者资料,采用单因素及多因素Logistic回归分析术后DPPB情况及其影响因素。[结果]ESD后DPPB发生率为6.3%。单因素分析结果提示影响除菌后早期胃癌及癌前病变ESD后DPPB的相关因素包括:合并糖尿病、合并慢性肾脏病、病变部位、病变最大径、病变浸润深度、病理类型、是否使用钛夹夹闭创面。多因素Logistic回归分析结果提示合并慢性肾脏病、病变部位、病变最大径是影响术后DPPB的独立危险因素。[结论]影响除菌后早期胃癌及癌前病变ESD后DPPB的发生存在多种因素,在进行ESD治疗前应针对相关危险因素进行管理和干预,制定有预见性的治疗方案,减少术后DPPB的风险。

[Objective]To investigate the status and influencing factors on delayed hemorrhage(DPPB)in early gastric cancer and precancerous lesions induced by ESD after Hp eradication.[Methods]The data of 397 patients with early gastric cancer and precancerous lesions treated with ESD after Hp eradication were retrospectively analyzed.Univariate and multivariate Logistic regression were used to analyze the postoperative delayed bleeding and its influencing factors.[Results]Delayed bleeding occurred in 25 patients after ESD,with an incidence of 6.3%.The results of single factor analysis suggested that the related factors affecting the delayed bleeding of early gastric cancer and precancerous lesion after Hp eradication included diabetes mellitus,chronic kidney disease,lesion site,maximum lesion diameter,infiltration depth,pathological type,and whether titanium clips were used to close the wound.Multivariate Logistic regression analysis showed that chronic kidney disease,lesion site and maximum lesion diameter were independent risk factors for postoperative delayed bleeding.[Conclusion]There are many factors that affect the occurrence of delayed bleeding after sterilization of early gastric cancer and endoscopic submucosal dissection of precancerous lesions.Management and intervention of related risk factors should be carried out before ESD treatment,and a predictable treatment plan should be formulated to reduce the risk of delayed bleeding after ESD treatment.