早期胃癌内镜黏膜下剥离术后患者迟发性出血发生情况调查及其影响因素分析

Investigation of delayed bleeding incidence and its risk factors in patients after endoscopic submucosal sissection for early gastric cancer

目的探究早期胃癌内镜黏膜下剥离术(ESD)后患者迟发性出血发生情况,分析其相关影响因素。方法回顾性分析2018年1月至2023年12月苏州市第九人民医院进行ESD治疗的早期胃癌患者102例临床资料,术后随访患者迟发性出血情况。分析调查早期胃癌ESD后迟发性出血的危险因素。结果102例患者中,有14例(13.7%)发生迟发性出血。迟发性出血组和未出血组病变最大径、内镜下病变大体形态、浸润深度、术中出血量比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,病变最大径≥3cm(OR=4.36,95%CI:1.268~15.091)、内镜下病变大体形态为浅表平坦型(OR=5.56,95%CI:1.495~20.647)、浸润深度为黏膜下层(OR=4.75,95%CI:1.401~16.107)、术中出血量≥800ml(OR=4.25,95%CI:1.325~13.658)是ESD术后迟发性出血的危险因素。结论早期胃癌ESD后患者迟发性出血发生情况,与病变最大径、内镜下病变大体形态、浸润深度和术中出血量的因素有关。

Objective To investigate the incidence of delayed bleeding after endoscopic submucosal dissection(ESD)for early gastric cancer and analyze its associated risk factors.Methods A retrospective analysis was conducted on the clinical data of 102patients with early gastric cancer who underwent ESD at Suzhou Ninth People's Hospital from January 2018 to December 2023.Postoperative follow-up was performed to monitor the occurrence of delayed bleeding.Risk factors for delayed bleeding after ESD in early gastric cancer were analyzed.Results Among the 102 patients,14(13.7%)patients developed delayed bleeding.Statistical analysis revealed significant differences in the maximum lesion diameter,endoscopic lesion morphology,infiltration depth,and intraoperative blood loss between the delayed bleeding group and the non-bleeding group(P<0.05).Multivariate logistic regression analysis showed that the following factors were associated with an increased risk of delayed bleeding after ESD:maximum lesion diameter≥3 cm(OR=4.36,95%CI:1.268–15.091),flat elevated type morphology on endoscopy(OR=5.56,95%CI:1.495-20.647),submucosal infiltration depth(OR=4.75,95%CI:1.401–16.107),and intraoperative blood loss≥800 ml(OR=4.25,95%CI:1.325-13.658).Conclusion The occurrence of delayed bleeding in patients after ESD for early gastric cancer is associated with factors such as the maximum lesion diameter,endoscopic lesion morphology,infiltration depth,and intraoperative blood loss.