胃间质瘤内镜黏膜下剥离术术后出血危险因素的研究
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摘要
目的探讨胃间质瘤患者内镜黏膜下剥离术(ESD)术后出血的危险因素。方法选取2015年1月至2018年12月间上海市复旦大学附属华山医院收治的98例胃间质瘤患者,采用Logistic多因素回归分析方法分析患者ESD术后出血的相关影响因素。结果 98例患者中,有3例(3. 1%)术后出血。出血组患者中高血压和透析比例明显高于无出血组,差异均有统计学意义(均P <0. 05)。出血组患者的平均手术时间长于无出血组患者,差异有统计学意义(P <0. 05)。Logistic多因素回归分析显示,透析和手术时间≥75min是ESD术后患者出血的独立影响因素,差异均有统计学意义(均P <0. 05)。结论胃间质瘤患者ESD术后出血的独立影响因素是采用透析治疗和手术时间≥75min。
Objective To determine the risk factors for postoperative hemorrhage in patients undergoing endoscopic submucosal dissection( ESD) for gastric stromal tumors. Methods Ninety-eight patients with gastric stromal tumors who underwent ESD at Huashan Hospital Affiliated to Fudan University from January 2015 to December 2018 were enrolled. The clinical factors of postoperative bleeding after ESD were analyzed using multivariate Logistic analysis. Results Among the 98 patients,hemorrhage was found in three patients( 3. 1%). Hypertension and dialysis rates were higher in patients with hemorrhage than patients without hemorrhage( all P < 0. 05). The average operation time was longer in patients with hemorrhage than in patients without hemorrhage( P < 0. 05). Multivariate Logistic regression analysis showed that dialysis and operative time ≥ 75 minutes was an independent risk factor for postoperative ESD bleeding( P <0. 05). Conclusion Dialysis operative time ≥ 75 min were independent risk factor for postoperative bleeding in patients undergoing ESD for gastric stromal tumors.
Objective To determine the risk factors for postoperative hemorrhage in patients undergoing endoscopic submucosal dissection( ESD) for gastric stromal tumors. Methods Ninety-eight patients with gastric stromal tumors who underwent ESD at Huashan Hospital Affiliated to Fudan University from January 2015 to December 2018 were enrolled. The clinical factors of postoperative bleeding after ESD were analyzed using multivariate Logistic analysis. Results Among the 98 patients,hemorrhage was found in three patients( 3. 1%). Hypertension and dialysis rates were higher in patients with hemorrhage than patients without hemorrhage( all P < 0. 05). The average operation time was longer in patients with hemorrhage than in patients without hemorrhage( P < 0. 05). Multivariate Logistic regression analysis showed that dialysis and operative time ≥ 75 minutes was an independent risk factor for postoperative ESD bleeding( P <0. 05). Conclusion Dialysis operative time ≥ 75 min were independent risk factor for postoperative bleeding in patients undergoing ESD for gastric stromal tumors.
引文
[1]Oka S,Tanaka S,Kaneko I,et al.Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer[J].Gastrointest Endosc,2006,64:877-883.
[2]Oda I,Saito D,Tada M,et al.A multicenter retrospective study of endoscopic resection for early gastric cancer[J].Gastric Cancer,2006,9:262-270.
[3]Yamamoto H,Kawata H,Sunada K,et al.Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood[J].Endoscopy,2003,35:690-694.
[4]罗华友,钟鸣,田衍,等.胃肠道间质瘤的诊断与外科治疗[J].中国肿瘤临床与康复,2010,17:239-241.
[5]Kang HY,Kim SG,Kim JS,et al.Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer[J].Surg Endosc,2010,24:509-516.
[6]Nakamoto S,Sakai Y,Kasanuki J,et al.Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan:a comparative study with endoscopic submucosal dissection[J].Endoscopy,2009,41:746-750.
[7]Chung I,Lee J,Lee S,et al.Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms:Korean ESD Study Group multicenter study[J].Gastrointest Endosc,2009,69:1228-1235.
[8]Okano A,Hajiro K,Takakuwa H,et al.Predictors of bleeding after endoscopic mucosal resection of gastric tumors[J].Gastrointest.Endosc,2003,57:687-690.
[9]Takizawa K,Oda I,Gotoda T,et al.Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection-an analysis of risk factors[J].Endoscopy,2008,40:179-183.
[10]Oda I,Goytoda T,Hamanaka H,et al.Endoscopic submucosal dissection for early gastric cancer:technical feasibility,operation time and complications from a large consecutive series[J].Dig.Endosc,2005,17:54-58.
[11]Jeon SW,Jung MK,Cho CM,et al.Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions[J].Surg Endosc,2009,23:1974-1979.
[12]Ono S,Fujishiro M,Niimi K,et al.Technical feasibility of endoscopic submucosal dissection for early gastric cancer in patients taking anti-coagulants or anti-platelet agents[J].Dig Liver Dis,2009,41:725-728.
[13]Jacobs LG,Billett HH,Freeman K,et al.Anticoagulation for stroke prevention in elderly patients with atrial fibrillation,including those with falls and/or early-stage dementia:a singlecenter,retrospective,observational study[J].Am J Geriatr Pharmacother,2009,7:159-166.
[14]Monagle P,Chalmers E,Chan A,et al.Antithrombotic and thrombolytic therapy for ischemic stroke:American college of chest physicians evidence-based clinical practice guidelines(8th Edition)[J].Chest,2008,133:887S-968S.
[15]Cheung J,Yu A,LaBossiere J,et al.Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease[J].Gastrointest.Endosc,2010,71:44-49.
[16]Ogura K,Okamoto M,Sugimoto T,et al.Efficacy and safety of endoscopic submucosal dissection for gastric cancer in patients with liver cirrhosis[J].Endoscopy,2008,40:443-445.
[2]Oda I,Saito D,Tada M,et al.A multicenter retrospective study of endoscopic resection for early gastric cancer[J].Gastric Cancer,2006,9:262-270.
[3]Yamamoto H,Kawata H,Sunada K,et al.Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood[J].Endoscopy,2003,35:690-694.
[4]罗华友,钟鸣,田衍,等.胃肠道间质瘤的诊断与外科治疗[J].中国肿瘤临床与康复,2010,17:239-241.
[5]Kang HY,Kim SG,Kim JS,et al.Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer[J].Surg Endosc,2010,24:509-516.
[6]Nakamoto S,Sakai Y,Kasanuki J,et al.Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan:a comparative study with endoscopic submucosal dissection[J].Endoscopy,2009,41:746-750.
[7]Chung I,Lee J,Lee S,et al.Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms:Korean ESD Study Group multicenter study[J].Gastrointest Endosc,2009,69:1228-1235.
[8]Okano A,Hajiro K,Takakuwa H,et al.Predictors of bleeding after endoscopic mucosal resection of gastric tumors[J].Gastrointest.Endosc,2003,57:687-690.
[9]Takizawa K,Oda I,Gotoda T,et al.Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection-an analysis of risk factors[J].Endoscopy,2008,40:179-183.
[10]Oda I,Goytoda T,Hamanaka H,et al.Endoscopic submucosal dissection for early gastric cancer:technical feasibility,operation time and complications from a large consecutive series[J].Dig.Endosc,2005,17:54-58.
[11]Jeon SW,Jung MK,Cho CM,et al.Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions[J].Surg Endosc,2009,23:1974-1979.
[12]Ono S,Fujishiro M,Niimi K,et al.Technical feasibility of endoscopic submucosal dissection for early gastric cancer in patients taking anti-coagulants or anti-platelet agents[J].Dig Liver Dis,2009,41:725-728.
[13]Jacobs LG,Billett HH,Freeman K,et al.Anticoagulation for stroke prevention in elderly patients with atrial fibrillation,including those with falls and/or early-stage dementia:a singlecenter,retrospective,observational study[J].Am J Geriatr Pharmacother,2009,7:159-166.
[14]Monagle P,Chalmers E,Chan A,et al.Antithrombotic and thrombolytic therapy for ischemic stroke:American college of chest physicians evidence-based clinical practice guidelines(8th Edition)[J].Chest,2008,133:887S-968S.
[15]Cheung J,Yu A,LaBossiere J,et al.Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease[J].Gastrointest.Endosc,2010,71:44-49.
[16]Ogura K,Okamoto M,Sugimoto T,et al.Efficacy and safety of endoscopic submucosal dissection for gastric cancer in patients with liver cirrhosis[J].Endoscopy,2008,40:443-445.