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结直肠肿瘤内镜黏膜下层剥离术穿孔的临床危险因素
引用本文:许松欣,丁岩冰. 结直肠肿瘤内镜黏膜下层剥离术穿孔的临床危险因素[J]. 胃肠病学和肝病学杂志, 2013, 0(12): 1212-1215
作者姓名:许松欣  丁岩冰
作者单位:[1]扬州市第一人民医院消化科,江苏扬州225001 [2]扬州大学医学院,江苏扬州225001
摘    要:目的 探讨和分析结直肠肿瘤内镜黏膜下层剥离术(endoscopic submucosal dissection,ESD)穿孔的危险因素.方法 选取2009年10月-2013年2月接受结直肠肿瘤ESD的199例患者.首先,对穿孔的发生率和临床操作过程进行评价.其次,对患者相关的变量(年龄、性别、阿司匹林或抗血小板制剂服用史及合并症)、内镜下的相关变量(肿瘤大小、位置和形态)、手术相关变量(手术者的经验、手术时间、黏膜下注射的药品)、病理诊断进行分析.结果 病变的平均大小为(15.9±10.6) mm.整体切除率为90.5%.20例(10.1%)患者发生了穿孔.16例(8.0%)患者保守治疗成功.肿瘤的类型(侧向发育型肿瘤)和位置(右半结肠)、内镜操作经验缺乏(〈50例)、未行黏膜下层透明质酸钠溶液注射与穿孔的高发生率相关(P〈0.05).结论 若是侧向发育型的肿瘤类型,ESD需更加谨慎及防止穿孔,进行长期黏膜保护尤为重要.

关 键 词:内镜黏膜下层剥离术  结直肠肿瘤  穿孔  危险因素

The clinical risk factors of perforation in colorectal neoplasm endoscopic submucosal dissection
XU Songxin,DING Yanbing. The clinical risk factors of perforation in colorectal neoplasm endoscopic submucosal dissection[J]. Chinese Journal of Gastroenterology and Hepatology, 2013, 0(12): 1212-1215
Authors:XU Songxin  DING Yanbing
Affiliation:1. Department of Gastroenterology, Yangzhou First People' s Hospital, Yangzhou 225001 ; 2. Clinical Medical School of Yangzhou University, China
Abstract:Objective To investigate and analyze the risk factors of colorectal neoplasm endoscopic submucosal dis- section (ESD) perforation. Methods Colorectal neoplasm ESD patients from Oct. 2009 to Feb. 2013 were selected. Firstly, the incidence of perforation and clinical operation were evaluated. Secondly, patients' variables (age, gender, history of aspirin or taking antiplatelet agents and complications) , relevant variables under endoscopy (tumor size, loca- tion and shape), variables related to the operation (operation experience, operation time, submucosal injection of drugs) and pathological diagnosis were analyzed. Results The average size of colorectal neoplasm was ( 15.9± 10.6) mm. The overall removal rate was 90.5%. 20 cases (10. 1% ) occurred perforation. 16 patients (8.0%) could be treated conservatively. Tumor type (laterally spreading tumor) and location (right-side colon), endoscopic operation experience lack ( 〈50 cases), no submucosa hyaluronic acid sodium solution injection may be associated with higher incidence of perforation (P 〈 0.05). Conclusion For laterally spreading tumor of tumor types, submucosa decollement should be more cautious and prevent perforation, long-term mucosal protection is particularly important.
Keywords:Endoscopic submucosal dissection  Colorectal neoplasm  Perforation  Risk factors
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