内镜黏膜下剥离术和内镜下黏膜切除术治疗早期胃癌的术后出血影响因素分析

目的：分析影响早期胃癌内镜黏膜下剥离术和内镜下黏膜切除术(ESD/EMR)术后出血的可能影响因素,以便降低出血风险,对术后出血高危人群进行特殊关注。方法：回顾性收集2012年6月至2018年5月于北京友谊医院内镜中心因诊断早期胃癌而行ESD/EMR治疗患者的临床资料,包括病人基本信息(年龄、性别、疾病史)、临床特征(病变大小、部位、形态)及术后病理信息(病理类型、浸润深度)等,分析上述因素对ESD/EMR术后发生出血的影响。结果：共有255例早期胃癌患者纳入研究,其中11例发生术后出血(4.3%)。术后出血病例与未出血病例相比,心脑血管疾病史、氯吡格雷服药史、多发病变在两组间分布有统计学差异 (P=0.004, P=0.017及P=0.042)。多因素分析显示心脑血管疾病史(OR=5.151, 95% CI：1.242-21.356, P=0.024)、多发病变(OR=7.245, 95% CI：1.471-35.684, P=0.015)及主要病变≥2cm (OR=4.713, 95%CI：1.011-21.982, P=0.048)是术后发生出血的可能危险因素。生存分析结果显示：有心脑血管疾病史(P<0.001)、多发病变(P=0.013)、主要病变≥2cm的患者(P=0.031),ESD/EMR术后发生出血的风险明显增高。结论：ESD/EMR术后应重点关注具有心脑血管疾病史、病变部位多发、病变较大的患者的出血风险。

Influencing factors of postoperative bleeding in endoscopic submucosal dissection and endoscopic mucosal resection of early gastric cancer

OBJECTIVE: To analyze the possible influencing factors of postoperative bleeding after endoscopic submucosal dissection/endoscopic mucosal resection (ESD/EMR) in early gastric cancer, in order to reduce the risk of surgery and pay special attention to the high risk group of postoperative bleeding. METHODS: The clinical data of patients underwent ESD/EMR for the diagnosis of early gastric cancer at the Endoscopy Center of Beijing Friendship Hospital from June 2012 to May 2018, including demographic information (age, gender, history of disease), endoscopic lesion characteristics (tumor size, location, morphology) and postoperative pathological features (differentiated types, invasive depth) to analyze the effects of these factors on bleeding after ESD/EMR surgery. RESULTS: A total of 255 patients with early gastric cancer were included in the study and 11 cases had postoperative bleeding (4.3%). The history of cardiovascular and cerebrovascular diseases, the history of clopidogrel and multiple lesions were statistically different between postoperative bleeding group and non-bleeding group (P=0.004, P=0.017 and P=0.042). Multivariate analysis showed a history of cardiovascular and cerebrovascular diseases (OR=5.151, 95% CI: 1.242-21.356, P=0.024), whether multiple lesions (OR=7.245, 95% CI: 1.471-35.684, P=0.015) and lesions size (OR = 4.713, 95% CI: 1.011-21.982, P = 0.048) were possible risk factors for postoperative bleeding. Survival analysis showed of higher postoperative bleeding risks in patients with the history of cardiovascular and cerebrovascular diseases (P<0.001), multiple lesions (P=0.013) and more than 2cm lesions size (P=0.031). Conclusion: The risk of ESD/EMR postoperative bleeding in early gastric cancer patients with a history of cardiovascular and cerebrovascular disease and multiple large lesions should be paid more attention.