结直肠内镜黏膜下剥离术后出血的危险因素分析
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摘要
目的探讨内镜黏膜下剥离术(ESD)治疗结直肠病变术后迟发性出血的危险因素。方法收集2016年6月至2018年10月在武汉大学人民医院消化内科采用ESD治疗的340例单个结直肠病变切除患者的临床资料,采用单因素和多因素分析方法分析引起术后迟发性出血的危险因素。结果 340例患者中21例(6. 17%)出现术后迟发性出血。单因素分析结果显示,术中明显出血的迟发性出血发生率高于无术中明显出血患者,术中抬举征阴性迟发性出血发生率高于阳性征患者(P <0. 05)。多因素Logistic回归分析结果显示,术中明显出血(P=0. 012,OR=4. 536,95%CI 1. 396～14. 744)、抬举征阴性(P=0. 014,OR=3. 571,95%CI 1. 289～9. 895)是结直肠ESD术后出血的危险因素。结论结直肠病变患者ESD抬举征阴性、术中有明显出血时,术后易发生迟发性出血,且术后应至少观察5 d。
Objective To investigate risk factors of delayed bleeding after endoscopic submucosal dissection( ESD) for colorectal lesions. Methods We retrospectively collected clinical data of 340 patients with colorectal lesions who received ESD in Renmin Hospital of Wuhan University from Jun. 2016 to Oct. 2018,and analyzed the risk factors of delayed bleeding after ESD by univariate and multivariable Logistic regression analysis. Results Delayed bleeding after ESD occurred in21( 3. 17%) out of the 340 patients. The results of single factor analysis showed that the incidence of delayed bleeding of patients with significant bleeding during operation was higher than that of the patients without significant intraoperative bleeding,and the incidence of patients with negative lifting sign during operation was higher than that of the positive( P <0. 05). Multivariable Logistic regression analysis showed that intraoperative bleeding( P = 0. 012,OR = 4. 536,95% CI1. 396-14. 744) and negative lifting sign( P = 0. 014,OR = 3. 571,95% CI 1. 289-9. 895) were risk factors for bleeding after colorectal ESD. Conclusion In patients with colorectal disease,the negative ESD lift sign,and obvious bleeding during the operation are correlated to delayed bleeding after operation,which requires a at least 5 day observation after ESD.
Objective To investigate risk factors of delayed bleeding after endoscopic submucosal dissection( ESD) for colorectal lesions. Methods We retrospectively collected clinical data of 340 patients with colorectal lesions who received ESD in Renmin Hospital of Wuhan University from Jun. 2016 to Oct. 2018,and analyzed the risk factors of delayed bleeding after ESD by univariate and multivariable Logistic regression analysis. Results Delayed bleeding after ESD occurred in21( 3. 17%) out of the 340 patients. The results of single factor analysis showed that the incidence of delayed bleeding of patients with significant bleeding during operation was higher than that of the patients without significant intraoperative bleeding,and the incidence of patients with negative lifting sign during operation was higher than that of the positive( P <0. 05). Multivariable Logistic regression analysis showed that intraoperative bleeding( P = 0. 012,OR = 4. 536,95% CI1. 396-14. 744) and negative lifting sign( P = 0. 014,OR = 3. 571,95% CI 1. 289-9. 895) were risk factors for bleeding after colorectal ESD. Conclusion In patients with colorectal disease,the negative ESD lift sign,and obvious bleeding during the operation are correlated to delayed bleeding after operation,which requires a at least 5 day observation after ESD.
引文
[1]Fitzmaurice C,Dicker D,Pain A,et al.The Global Burden of Cancer 2013[J].JAMA Oncol,2015,1(4):505-527.
[2]Zauber AG,Winawer SJ,O'Brien MJ,et al.Colonoscopic polypectomy and long term prevention of colorectal cancer deaths[J].N Engl J Med,2012,366(8):687-696.
[3]Saito Y,Fukuzawa M,Matsuda T,et al.Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection[J].Surg Endosc,2010,24(2):343-352.
[4]Femandez Esparrach G,Calderon A,De-la-Pena J,et al.Endoscopic submucosal dissection.Sociedad Espanola de Endoscopia Digestiva(SEED)clinical guideline[J].Rev Esp Enferm Dig,2014,106(2):120-132.
[5]Hayashi N,Tanaka S,Nishiyama S,et al.Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors[J].Gastrointest Endosc,2014,79(3):427-435.
[6]Sato K,Ito S,Kitagawa T,et al.Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors[J].Surg Endosc,2014,28(10):2959-2965.
[7]Bae JH,Yang DH,Lee S,et al.Optimized hybrid endoscopic submucosal dissection for colorectal tumors:A randomized controlled trial[J].Gastrointest Endosc,2016,83(3):584-592.
[8]Hong MJ,Kim JH,Lee SY,et al.Prevalence and clinical features of coagulation syndrome after endoscopic submucosal dissection for colorectal neoplasms[J].Digest Dis Sci,2015,60(1):211-216.
[9]Lee SP,Kim JH,Sung IK,et al.Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors:Pathologic review of 173 cases[J].J Gastroenterol Hepatol,2015,30(5):872-878.
[10]Lee EJ,Lee JB,Lee SH,et al.Endoscopic submucosal dissection for colorectal tumors-1,000 colorectal ESD cases:One specialized institute's experiences[J].Surg Endosc,2013,27(1):31-39.
[11]Terasaki M,Tanaka S,Oka S,et al.Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm[J].J Gastroenterol Hepatol,2012,27(4):734-740.
[12]Ma MX,Bourke MJ.Complications of endoscopic polypectomy,endoscopic mucosal resection and endoscopic submucosal dissection in the colon[J].Best Pract Res Clin Gastroenterol,2016,30(5):749-767.
[13]Fujiya M,Tanaka K,Dokoshi T,et al.Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms:A meta-analysis of studies comparing EMR and endoscopic submucosal dissection[J].Gastrointest Endosc,2015,81(3):583-595.
[14]林洁,戴海峰.结直肠肿瘤ESD术后迟发性出血的危险因素分析[J].大连医科大学学报,2014,36(6):568-571.
[15]Arimoto J,Higurashi T,Chiba H,et al.Continued Use of a Single Antiplatelet Agent Does Not Increase the Risk of Delayed Bleeding After Colorectal Endoscopic Submucosal Dissection[J].Dig Dis Sci,2018,63(1):218-227.
[16]Toyonaga T,Man-i M,East JE,et al.1,635 Endoscopic submucosal dissection cases in the esophagus,stomach,and colorectum:Complication rates and long-term outcomes[J].Surg Endosc,2013,27(3):1000-1008.
[17]Zeng H,Zheng R,Guo Y,et al.Cancer survival in China,2003-2005:A population based study[J].Int J Cancer,2015,136(8):1921-1930.
[18]Terasaki M,Tanaka S,Shigita K,et al.Risk factors for delayed bleeding afteren doscopic submucosal dissection for colorectal neoplasms[J].Int J Colorectal Dis,2014,29(7):877-882.
[19]王洪波,刘苗,徐明垚,等.内镜黏膜下剥离术治疗早期结直肠癌及癌前病变术后迟发性出血的危险因素分析[J].实用医学杂志,2018,34(6):978-986.
[20]苟丽,李莉,李紫琼,等.直肠黏膜病变内镜下黏膜剥离术后出血的相关危险因素分析[J].世界最新医学信息文摘,2015,15(27):54-55.
[21]钟芸诗,姚礼庆,许剑民,等.内镜黏膜下剥离术治疗直肠扁平癌前期疾病和黏膜内癌临床价值[J].中国实用外科杂志,2011,10(6):497-500.
[22]Yamashina T,Takeuchi Y,Uedo N,et al.Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm[J].J Gastroenterol Hepatol,2016,31(3):615-620.
[23]Suzuki S,Chino A,Kishihara T,et al.Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms[J].World J Gastroenterol,2014,20(7):1839-1845.
[24]Suzuki T,Hara T,Kitagawa Y,et al.Feasibility of endoscopic submucosal dissection for cecal lesions[J].Scand J Gastroenterol,2018,53(3):359-364.
[25]Higashiyama M,Oka S,Tanaka S,et al.Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm[J].Dig Endosc,2011,23(4):290-295.
[26]Ogasawara N,Yoshimine T,Noda H,et al.Clinical risk factors for delayed bleeding afterendoscopicsubmucosaldissection for colorectal tumors in Japanesepatients[J].Eur J Gastroenterol Hepatol,2016,28(12):1407-1414.
[27]Youk EG,Sohn DK,Hong CW,et al.Early outcomes of endoscopic submucosal dissection for colorectal neoplasms according to clinical indications[J].Dis Colon Rectum,2016,59(5):403-410.
[28]韩铁妹,张晨静,潘文胜,等.内镜黏膜下剥离术失败的危险因素分析[J].实用肿瘤杂志,2012,27(6):587-592.
[29]Kim ES,Cho KB,Park KS,et al.Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors[J].Endoscopy,2011,43(7):573-578.
[30]Ogiyama H,Tsutsui S,Murayama Y,et al.Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection[J].Endosc Int Open,2018,6(5):E582-588.
[2]Zauber AG,Winawer SJ,O'Brien MJ,et al.Colonoscopic polypectomy and long term prevention of colorectal cancer deaths[J].N Engl J Med,2012,366(8):687-696.
[3]Saito Y,Fukuzawa M,Matsuda T,et al.Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection[J].Surg Endosc,2010,24(2):343-352.
[4]Femandez Esparrach G,Calderon A,De-la-Pena J,et al.Endoscopic submucosal dissection.Sociedad Espanola de Endoscopia Digestiva(SEED)clinical guideline[J].Rev Esp Enferm Dig,2014,106(2):120-132.
[5]Hayashi N,Tanaka S,Nishiyama S,et al.Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors[J].Gastrointest Endosc,2014,79(3):427-435.
[6]Sato K,Ito S,Kitagawa T,et al.Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors[J].Surg Endosc,2014,28(10):2959-2965.
[7]Bae JH,Yang DH,Lee S,et al.Optimized hybrid endoscopic submucosal dissection for colorectal tumors:A randomized controlled trial[J].Gastrointest Endosc,2016,83(3):584-592.
[8]Hong MJ,Kim JH,Lee SY,et al.Prevalence and clinical features of coagulation syndrome after endoscopic submucosal dissection for colorectal neoplasms[J].Digest Dis Sci,2015,60(1):211-216.
[9]Lee SP,Kim JH,Sung IK,et al.Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors:Pathologic review of 173 cases[J].J Gastroenterol Hepatol,2015,30(5):872-878.
[10]Lee EJ,Lee JB,Lee SH,et al.Endoscopic submucosal dissection for colorectal tumors-1,000 colorectal ESD cases:One specialized institute's experiences[J].Surg Endosc,2013,27(1):31-39.
[11]Terasaki M,Tanaka S,Oka S,et al.Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm[J].J Gastroenterol Hepatol,2012,27(4):734-740.
[12]Ma MX,Bourke MJ.Complications of endoscopic polypectomy,endoscopic mucosal resection and endoscopic submucosal dissection in the colon[J].Best Pract Res Clin Gastroenterol,2016,30(5):749-767.
[13]Fujiya M,Tanaka K,Dokoshi T,et al.Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms:A meta-analysis of studies comparing EMR and endoscopic submucosal dissection[J].Gastrointest Endosc,2015,81(3):583-595.
[14]林洁,戴海峰.结直肠肿瘤ESD术后迟发性出血的危险因素分析[J].大连医科大学学报,2014,36(6):568-571.
[15]Arimoto J,Higurashi T,Chiba H,et al.Continued Use of a Single Antiplatelet Agent Does Not Increase the Risk of Delayed Bleeding After Colorectal Endoscopic Submucosal Dissection[J].Dig Dis Sci,2018,63(1):218-227.
[16]Toyonaga T,Man-i M,East JE,et al.1,635 Endoscopic submucosal dissection cases in the esophagus,stomach,and colorectum:Complication rates and long-term outcomes[J].Surg Endosc,2013,27(3):1000-1008.
[17]Zeng H,Zheng R,Guo Y,et al.Cancer survival in China,2003-2005:A population based study[J].Int J Cancer,2015,136(8):1921-1930.
[18]Terasaki M,Tanaka S,Shigita K,et al.Risk factors for delayed bleeding afteren doscopic submucosal dissection for colorectal neoplasms[J].Int J Colorectal Dis,2014,29(7):877-882.
[19]王洪波,刘苗,徐明垚,等.内镜黏膜下剥离术治疗早期结直肠癌及癌前病变术后迟发性出血的危险因素分析[J].实用医学杂志,2018,34(6):978-986.
[20]苟丽,李莉,李紫琼,等.直肠黏膜病变内镜下黏膜剥离术后出血的相关危险因素分析[J].世界最新医学信息文摘,2015,15(27):54-55.
[21]钟芸诗,姚礼庆,许剑民,等.内镜黏膜下剥离术治疗直肠扁平癌前期疾病和黏膜内癌临床价值[J].中国实用外科杂志,2011,10(6):497-500.
[22]Yamashina T,Takeuchi Y,Uedo N,et al.Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm[J].J Gastroenterol Hepatol,2016,31(3):615-620.
[23]Suzuki S,Chino A,Kishihara T,et al.Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms[J].World J Gastroenterol,2014,20(7):1839-1845.
[24]Suzuki T,Hara T,Kitagawa Y,et al.Feasibility of endoscopic submucosal dissection for cecal lesions[J].Scand J Gastroenterol,2018,53(3):359-364.
[25]Higashiyama M,Oka S,Tanaka S,et al.Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm[J].Dig Endosc,2011,23(4):290-295.
[26]Ogasawara N,Yoshimine T,Noda H,et al.Clinical risk factors for delayed bleeding afterendoscopicsubmucosaldissection for colorectal tumors in Japanesepatients[J].Eur J Gastroenterol Hepatol,2016,28(12):1407-1414.
[27]Youk EG,Sohn DK,Hong CW,et al.Early outcomes of endoscopic submucosal dissection for colorectal neoplasms according to clinical indications[J].Dis Colon Rectum,2016,59(5):403-410.
[28]韩铁妹,张晨静,潘文胜,等.内镜黏膜下剥离术失败的危险因素分析[J].实用肿瘤杂志,2012,27(6):587-592.
[29]Kim ES,Cho KB,Park KS,et al.Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors[J].Endoscopy,2011,43(7):573-578.
[30]Ogiyama H,Tsutsui S,Murayama Y,et al.Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection[J].Endosc Int Open,2018,6(5):E582-588.