摘要
目的应用倾向评分配比探讨内镜下黏膜剥离术(ESD)应用玻璃酸钠+肾上腺素+靛胭脂+生理盐水混合溶液黏膜下注射的临床疗效、安全性和可行性。方法回顾性分析了2015年6月至2019年12月间于联勤保障部队第九〇〇医院内镜中心行胃镜检查发现胃部病变并且符合入组条件的293例患者的临床资料,将纳入患者分为研究组和对照组两组并作为因变量,各临床指标作为自变量,通过Logistic回归估计倾向评分值,采用倾向评分配比1∶1最近邻居匹配法进行匹配,定义卡钳值为0.1来保证匹配结果的优良性,检验配比后两组临床指标的均衡性,LSD-t检验和χ^(2)检验比较配比后两组患者给药剂量、手术操作时间以及术中术后并发症,采用Logistic回归模型评价配比前后研究组对术后发生迟发性出血的影响,P <0.05为差异有统计学意义。结果使用倾向评分配比法,结果 109例患者未完成配对,其中对照组患者69例,研究组患者40例;92对患者(对照组和研究组患者各92例)完成配对,两组间不平衡的临床指标经匹配后均达到平衡,差异均无统计学意义,具有可比性。配比后研究组平均手术操作时间(66.5±20.4) min及黏膜下注射液用量(45.4±13.7) mL显著低于对照组的(78.7±22.9) min及(61.2±16.5) mL(P=0.013,0.019);研究组平均术中出血量(114.3±39.5) mL显著低于对照组的(156.6±41.3) mL(P=0.002);两组术中均未发生穿孔,研究组术后发生迟发性出血率显著低于对照组(2/90 vs 9/83,P=0.050),研究组术后发生迟发性穿孔率虽低于对照组,但差异无统计学意义(2/90 vs 5/87,P=0.154);配比前后,在Logistic单因素和2个校正的多因素模型中,相较于对照组,研究组均显著降低患者术后发生迟发性出血风险(HR:0.74,95%CI:0.39~0.92;HR:0.77,95%CI:0.45~0.97;均P <0.05)。结论对于胃部癌前病变或早癌,ESD应用玻璃酸钠+肾上腺素+靛胭脂+生理盐水混合溶液黏膜下注射可降
Objective To investigate the clinical efficacy,safety and feasibility of submucosal injection of sodium hyaluronate+adrenaline+indigo carmine+normal saline in endoscopic mucosal dissection(ESD)using propensity score matching analysis.Methods The clinical data of 293 patients with gastric lesions found by gastroscopy in endoscopy center of 900th Hospital of joint service support force from June 2015 to December 2019 were retrospectively analyzed.The patients were divided into study group and control group as dependent variables,and clinical indicators as independent variables.The tendency score was estimated by logistic regression.The tendency score was matched by 1∶1 nearest neighbor matching method.The calipers value was defined as 0.1 to ensure the excellent matching results.The balance of clinical indicators in the two groups was tested after matching.LSD-t test and2 test were used to compare the dosage,operation time and intraoperative and postoperative complications between the two groups after matching.Logistic regression model was used to evaluate the effect of the study group on the occurrence of delayed bleeding before and after the matching,P<0.05,the difference was statistically significant.Results Using propensity score matching method,109 patients did not complete the matching,including 69 patients in the control group and 40 patients in the study group;92 pairs of patients(92 cases in the control group and 92 cases in the study group)completed the pairing,and the clinical indicators of imbalance between the two groups were balanced after matching,and the difference was not statistically significant,so it was comparable.The average operation time and the amount of submucosal injection in the study group were(66.5±20.4)min and(45.4±13.7)ml,which were significantly lower than those in the control group(78.7±22.9)min and(61.2±16.5)ml(P=0.013,0.019),and the average intraoperative blood loss in the study group was(114.3±39.5)ml,which was significantly lower than that in the control group(156.6±
作者
姚荔嘉
江银蒜
柳刚
王雯
YAO Li-jia;JIANG Yin-suan;LIU Gang;WANG Wen(Department of Gastroenterology, 900th Hospital of joint logistics support force, Fuzhou, Fujian 350025,China)
出处
《现代消化及介入诊疗》
2021年第1期51-55,67,共6页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
福建省科技计划项目(2018Y9116)。
关键词
内镜下黏膜剥离术
黏膜下注射
倾向评分配比
术后并发症
迟发性出血
迟发性穿孔
Endoscopic mucosal dissection
Submucosal injection
Propensity score matching
Postoperative complications
Delayed hemorrhage
Delayed perforation
