内镜黏膜下剥离术治疗早期食管癌及癌前病变术后延迟性出血的危险因素分析
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湖北省自然科学基金、省重点实验室建设(2014CFA139)


Risk factors for esophageal delayed bleeding after endoscopic submucosal dissection of early esophageal carcinoma and precancerous lesions
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    摘要:

    目的 探讨内镜黏膜下剥离术(ESD)治疗早期食管癌及癌前病变发生术后延迟性出血的可能危险因素。方法 回顾性分析ESD治疗的281例早期食管癌及癌前病变患者的部分临床资料,分别采用单因素分析及多因素非条件Logistic回归分析探讨引起延迟性出血的危险因素。结果 ESD治疗的281例早期食管癌及癌前病变患者中,22例发生延迟性出血,发生率约为7.83%。卡方检验发现,发生延迟性出血组和未发生延迟性出血组在患者年龄构成(P=0.046)、病灶大小构成(P=0.013)、病灶浸润深度构成(P<0.001)方面差异均有统计学意义。以上3个危险因素连同卡方检验提示P<0.10的术中出血(P=0.068)经多因素非条件Logistic回归分析后发现,仅病灶浸润深度是早期食管癌及癌前病变ESD术后发生延迟性出血的独立危险因素(P=0.002,OR=6.88,95%CI:1.07~39.28)。结论 年龄≥60岁及直径≥3 cm的早期食管癌及癌前病变患者ESD术后易发延迟性出血,但其直接原因为病灶浸润深度,浸润深度越深越易发生术后延迟性出血。

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    Objective To identify the possible risk factors for esophageal delayed bleeding after endoscopic submucosal dissection(ESD) of early esophageal carcinoma and precancerous lesions. Methods Data of 281 patients with early esophageal carcinoma and precancerous lesions treated by ESD were reviewed. Risk factors for esophageal delayed bleeding were investigated by univariate analysis and logistic multivariable regression analysis. Results Esophageal delayed bleeding occurred in 22 patients(7.83%). Univariate analysis showed there was significant difference between delayed bleeding group and non-delayed bleeding group in regard of age(P=0.046), lesion size(P=0.013), and lesion infiltration depth(P<0.001). Together with three factors above, the intraoperative bleeding(P=0.068) was also analyzed by Logistic multivariable regression analysis which showed only infiltration depth was the independent risk factor of early esophageal carcinoma and precancerous lesions treated by ESD(P=0.002,OR=6.88,95%CI:1.07-39.28). Conclusion Patients older than 60 years and diameters more than 3 cm might be prone to delayed bleeding, but the direct factor is infiltration depth. The deeper lesions infiltrate, the delayed bleeding is more likely to occur.

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李艳霞,沈磊,于红刚.内镜黏膜下剥离术治疗早期食管癌及癌前病变术后延迟性出血的危险因素分析[J].中华消化内镜杂志,2017,34(2):118-121.

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