摘要
目的总结胃内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术中出血的临床特点,分析导致出血的危险因素。方法回顾性总结2015年1月—2019年12月北京协和医院消化内镜中心所有接受胃ESD治疗的患者,分析患者病史资料、胃内病变特点、操作过程及患者预后。结果共纳入422例患者的437处病变,其中胃上皮性肿瘤406例。ESD术中出血率为32.3%(141/437),其中急性大出血2例。ESD术中出血可增加肌层损伤和术中穿孔的发生概率,延长操作时间,多因素回归分析发现ESD术中出血的发生主要与术中解剖粘连、病变位于上中2/3胃、标本面积≥15 cm^(2)、男性、非ESD绝对适应证相关。结论术中出血是胃ESD操作的限速因素,应注意把握操作适应证,对于男性患者、病变位于上中2/3胃、切除标本较大或术中存在解剖粘连时,应注意预防术中出血的发生。
Objective To summarize the clinical characteristics of bleeding during endoscopic submucosal dissection(ESD)and to analyze the risk factors for bleeding.Methods Data of patients who received gastric ESD in endoscopy center of Peking Union Medical College Hospital from January 2015 to December 2019 were reviewed.The medical history,characteristics of gastric lesions,operation process and prognosis of the patients were analyzed.Results A total of 437 gastric lesions of 422 patients were included in this study,and 406 lesions were gastric epithelial tumors.The bleeding rate during ESD was 32.3%(141/437),including 2 cases of acute massive hemorrhage.Intraoperative hemorrhage during ESD increased the incidence of myometrial injury and intraoperative perforation,and prolonged the operation time.Multivariate regression analysis showed that risk factors for bleeding during ESD were anatomical adhesion,the lesion location in the upper and middle 2/3 of the stomach,the lesion area≥15 cm^(2),male,and non-ESD absolute indications.Conclusion Bleeding is the speed limiting factor for gastric ESD.For male patients,when the lesion is located in the upper and middle 2/3 of the stomach,large with anatomical adhesion during operation,precaution should be taken for intraoperative hemorrhage.
作者
王强
吴晰
蒋青伟
郭涛
冯云路
伍东升
张晟瑜
杨爱明
Wang Qiang;Wu Xi;Jiang Qingwei;Guo Tao;Feng Yunlu;Wu Dongsheng;Zhang Shengyu;Yang Aiming(hinese Academy of Medical Sciences and Peking Union Medical College Department of Gastroenterology,Peking Union Medical College Hospital,Beijing 100730,China)
出处
《中华消化内镜杂志》
CSCD
2021年第6期428-433,共6页
Chinese Journal of Digestive Endoscopy
基金
国家重点研发计划课题(2016YFC1302802)。
关键词
胃肿瘤
出血
危险因素
内镜黏膜下剥离术
Stomach neoplasms
Hemorrhage
Risk factors
Endoscopic submucosal dissection
