结直肠内镜黏膜下剥离术后发热的危险因素分析

[目的]探讨内镜黏膜下剥离术(ESD)治疗结直肠病变术后发热的危险因素。[方法]回顾性分析行结直肠ESD的347例患者的临床资料,对病例的年龄、性别、既往病史、病变位置、病变大小、病理、术中不良事件、ESD操作时长、术后创面处理、围术期抗生素使用情况、ESD后住院时间、术后不良事件等进行单因素及多因素分析,总结术后发热的危险因素。[结果]347例患者术后发热率为4.6%(16/347),发热最高体温(38.1±0.4)℃,发热天数(2.6±1.5)d。通过单因素及多因素分析,术中出血或术中穿孔(OR=0.481,95%CI=0.267～0.867,P=0.015)、术后迟发出血或迟发穿孔(OR=0.323,95%CI=0.105～0.991,P=0.048)以及病灶累及固有肌层(OR=0.320,95%CI=0.143～0.716,P=0.006)是结直肠EDS后发热的独立危险因素。[结论]术中出血或术中穿孔、术后迟发出血或迟发穿孔以及病灶累及固有肌层是结直肠EDS后发热的独立危险因素,应给予此类患者更多的观察及处理,以期降低术后发热率。     

早期结直肠肿瘤内镜黏膜下剥离术非治愈性切除的危险因素研究进展

结直肠癌是消化道常见的恶性肿瘤之一.内镜黏膜下剥离术(ESD)已广泛应用于早期结直肠肿瘤的治疗.早期结直肠肿瘤ESD非治愈性切除的危险因素已在多项研究中得到证实.本文就早期结直肠肿瘤ESD非治愈性切除危险因素的研究进展作一综述.     

内镜下黏膜剥离术治疗直径≥20 mm结直肠侧向发育肿瘤并发出血及穿孔的危险因素分析

目的 探讨内镜下黏膜剥离术(ESD)治疗直径≥20 mm的结直肠侧向发育肿瘤(LST)并发出血、穿孔的影响因素。方法 纳入2016年1月～2019年12月病变直径≥20 mm且行ESD治疗的结直肠LST患者172例,根据术后是否并发出血或穿孔,将172例患者分别分为出血组(9例)和非出血组(163例)、穿孔组(14例)和非穿孔组(158例)。对入组患者并发出血、穿孔的危险因素进行分析。结果 出血发生率为5.23%,穿孔发生率为8.14%,手术时间≥120 min是ESD治疗直径≥20 mm结直肠LST并发出血的独立危险因素(OR=0.205,95%CI 0.051～0.822,P=0.025),高龄(OR=0.945,95%CI 0.897～0.996,P=0.035)及病灶纤维化(OR=0.105,95%CI 0.027～0.405,P=0.001)是ESD治疗直径≥20 mm结直肠LST发生穿孔的独立危险因素。结论 在ESD治疗直径≥20 mm的结直肠LST过程中,手术时间≥120 min为术后并发出血的危险因素,高龄及病灶纤维化会增加穿孔发生的可能。     

结直肠内镜黏膜下剥离术术后迟发性出血的危险因素分析

结直肠癌是消化系统最常见的恶性肿瘤之一,死亡率较高,我国结直肠癌的发病率也逐年增高[1].随着内镜技术的发展及普及,结直肠癌及癌前病变的筛查、诊断及治疗有了明显进展.大多数结直肠癌是由各类腺瘤最终发展为癌,此过程可能持续10年左右,因此早期切除肿瘤前体病变可以有效避免结直肠癌的进展[2].目前内镜下微创治疗的主要方法包...     

结直肠侧向发育型肿瘤内镜黏膜下剥离术手术时长的影响因素

目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗结直肠侧向发育型肿瘤（laterally spreading tumor,LST）手术时长的影响因素。方法回顾性纳入于2013年6月—2019年3月在北京市消化疾病中心行ESD治疗的结直肠LST患者。对ESD手术时间延长（≥60 min）的影响因素先进行单因素分析,对于其中有统计学差异的因素再纳入多因素Logistic回归分析独立危险因素。结果纳入了201位患者,年龄(65.05±10.44)岁,其中男性占53.73%。患者有病变213处,病变长径(2.52±1.67)cm。病变整块切除率、完整切除率和治愈性切除率分别为93.90%、84.04%和79.81%。术中穿孔率、迟发穿孔率和迟发出血率分别为1.88%、0.94%和1.41%。单因素分析显示,病变直径≥3 cm（OR=13.48,P<0.001）、结节混合型（OR=25.28,P=0.002）、颗粒均一型（OR=9.00,P=0.045）、位于直乙部位（OR=3.08,P=0.002）以及抬举征阴性（OR=3.40,P=0.012）与ESD手术时间延长相关。多因素Logistic回归分析表明,直径≥3 cm（OR=9.29,P<0.001）、结节混合型（OR=8.80,P=0.043）和抬举征阴性（OR=3.43,P=0.043）是手术时间延长的独立危险因素。ESD手术时间延长,病变的完整切除率（69.56%比88.55%,P=0.003）和治愈性切除率（63.64%比85.50%,P=0.002）显著降低,发生癌变的风险显著升高（86.96%比51.91%,P<0.001）。结论当LST直径≥3 cm、结节混合型或抬举征阴性时,ESD的手术时间延长。手术时间越长,ESD的切除效率越低,病变发生癌变的风险越高。     

结直肠内镜黏膜下剥离术并发症的研究进展

内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)是治疗消化道早癌及癌前病变的一种有效方法,已广泛应用于临床实践.结直肠因管腔窄、肠袢弯曲角度大、黏膜薄等解剖特点,该部位的ESD操作难度较大,出血及穿孔等并发症的发生率也较高.如何有效地减少结直肠ESD术后并发症的发生一直是临床...     

内镜黏膜下剥离术治疗结直肠病变的临床分析

目的 探讨内镜黏膜下剥离术（ESD）治疗结直肠病变的安全性和有效性。 方法 回顾性分析2012年6月至2016年6月在北京大学第一医院内镜中心接受ESD治疗的163例结直肠病变患者资料,对病变的临床病理特征、整块切除率、完全切除率、并发症发生率及复发率进行统计分析。 结果 163例病变中黏膜病变118例,包括隆起型病变31例,平坦型病变22例,侧向发育型肿瘤65例;黏膜下病变45例,均为隆起型病变。病变中位直径2.2（2.0）cm,手术时间42（53）min。整块切除率92.6％（151／163）,完全切除率86.5％（141／163）,病变大小与整块切除率及完全切除率相关（P＜0.05）。4例发生ESD相关并发症,其中2例为术中出血,1例为术后迟发出血,经内镜下确切止血后好转;1例术后迟发性穿孔,经外科手术治疗后好转。135例随访患者中4例出现复发,3例再次内镜下切除,1例手术切除。 结论 ESD治疗结直肠病变是安全有效的。达到整块切除及完全切除的患者可获得良好的长期预后。     

内镜黏膜下剥离术治疗结直肠浅表性肿瘤性病变的术后随访

[目的]探讨结直肠浅表性肿瘤性病变行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后临床病理特征、术后并发症及非治愈性ESD的相关危险因素及追加手术的必要性.[方法]回顾性分析本院因结直肠浅表性肿瘤性病变行ESD治疗的383例患者的临床资料,分析其一般临床特点、病理特征及预...     

结直肠隆起性病变内镜下黏膜剥离术后并发症的相关研究

结直肠隆起性病变是消化系统常见的肠道疾病,其治疗方案包括外科手术和内镜下治疗。外科手术治疗创伤较大、患者术后并发症较多、住院时间较长,且高龄及有心脑血管疾病患者手术风险较高,不宜作为其治疗首选。目前,内镜下治疗已成为结直肠隆起性病变的常规治疗方式。内镜下黏膜剥离术(ESD)治疗结直肠隆起性病变的整体切除率较高,局部复发率较低[1-2],对于直径>2 cm的病变,ESD已成为其首选治疗方法[3],但ESD可能引起出血及穿孔等并发症。本研究收集我科近期收治的结直肠隆起性病变患者的临床资料,分析可能导致并发症的危险因素,以期提高临床医师认识,减少相关并发症发生。     

Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

AIM: To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study.METHODS: We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and “silent” free air without endoscopically visible perforation detected only by computed tomography.RESULTS: Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air.CONCLUSION: Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air.     

内镜黏膜下剥离术后发热相关危险因素分析

目的探讨消化道黏膜或黏膜下病变经内镜下黏膜剥离术后发热情况及其相关危险因素。方法回顾分析自2009年11月至2012年4月间270例因消化道黏膜或黏膜下病变行内镜下黏膜剥离术（ESD）患者的相关临床、内镜及病理资料,统计分析以下相关因素：（1）患者相关因素：如性别、年龄、糖尿病史、呼吸系统等其他慢性病史,吸烟史、过敏史、术前预防性使用抗生素情况、白细胞计数。（2）病变相关因素：病变位置、病变大小、浸润深度。（3）操作相关因素：麻醉方式、是否整块切除、术中出血量、操作时间、是否穿孔。结果纳入研究者总共有病例270例,病变275处。56例患者发生ESD术后发热,发生率为20．7％,其中31例（55．4％）在术后24h内发生,发热持续时间为1—8d,平均（1．7±1．4）d,通过单因素及多因素分析,术中穿孔（OR值7．121,95％ CI： 1．740～29．151）及病变位于食管（OR值0．181,95％CI：0．091—0．361）是ESD术后发热的相关危险因素。结论术中穿孔及病变位于食管是ESD术后发热的危险因素,对于食管病变及术中出现穿孔的病例,应警惕术后发热,并予相应处理。     

内镜黏膜下剥离术的疗效及出血危险因素分析

目的 分析内镜黏膜下剥离术( ESD)治疗消化道黏膜浅表性病变的有效性及并发症的危险因素.方法 前瞻性观测上海长海医院应用ESD治疗154例消化道浅表性病变的效果以及并发症发生情况,并对后者发生率较高的出血及其相关危险因素进行统计学分析.结果 完成ESD的145例中,一次性整块切除率100.0％,其中组织学完全治愈性切除率99.3％;9例因术中出血(5例)或穿孔(4例)未能完成ESD.发生术中大量出血6例(6/154,3.9％),少量出血5例(3.2％),术后延迟出血1例(0.6％),消化道穿孔4例(2.6％),消化道狭窄1例(0.6％),以上均经相应治疗后好转,无死亡病例.术后残留1例,经再次ESD治愈.术后8周复查,溃疡愈合率100％;平均随访10.6(8 ～18)个月,无局部复发.ESD出血并发症的独立危险因素为:病变部位(贲门胃底部),病变面积(随着病变面积增大其危险度提高).结论 ESD是治疗消化道浅表性病变安全、有效的方法,严格掌握手术适应证、个体化治疗,有助于降低并发症发生.     

Severe splenic rupture after colorectal endoscopic submucosal dissection

Splenic rupture (SR) after colonoscopy is a very rare but potentially serious complication. Delayed diagnosis is common, and may increase morbidity and mortality associated. There is no clear relation between SR and difficult diagnostic or therapeutic procedures, but it has been suggested that loop formation and excessive torquing might be risk factors. This is a case of a 65-year-old woman who underwent endoscopic submucosal dissection (ESD) for lateral spreading tumor in the descending colon, and 36 h afterwards presented symptoms and signs of severe hypotension due to SR. Standard splenectomy was completed and the patient recovered uneventfully. Colorectal ESD is usually a long and position-demanding technique, implying torquing and loop formation. To our knowledge this is the first case of SR after colorectal ESD reported in the literature. Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication.     

Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications

Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is r...     

内镜下胃黏膜剥离术后出血的相关危险因素分析

目的 探讨胃黏膜病变经内镜黏膜下剥离术(ESD)后出血情况及其相关危险因素.方法 回顾性分析自2009年1月至2011年10月间215例因胃黏膜病变行ESD患者的相关临床、内镜及病理资料,统计分析以下相关因素:(1)患者相关因素:如性别、年龄、伴发高血压、糖尿病及其他慢性病,既往服用抗凝药物等情况;(2)病变相关因素:病变大小、部位,表面溃疡或瘢痕情况,大体形态,病理类型;(3)操作相关因素:整块切除情况,创面喷洒猪源纤维蛋白粘合剂,操作时间等因素.结果 纳入研究病例对应病变共有223处,有13例患者(13处病变)发生ESD术后出血,其中7例(53.8％)于术后24h内发生出血,5例(38.5％)于术后1周内发生出血,1例(7.7％)发生于术后第16天.通过单因素与多因素分析,病变长度≥5.0 cm(OR值8.663,95％CI:2.081 ～ 36.075)是ESD术后出血的独立危险因素.结论 病变大小为ESD术后出血的独立危险因素,对于较大病变,ESD术中与术后应予重视,同时应优化ESD术前评估使病变最小化以预防术后出血.     

结直肠内镜黏膜下剥离术中出血的危险因素分析

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗结直肠病变并发术中出血情况, 并分析其危险因素。方法回顾分析2019年12月—2021年8月大同市第三人民医院及其合作单位南京鼓楼医院行结直肠ESD治疗的386例患者病例资料, 按术中出血情况分为出血组(n=85)和未出血组(n=301)。分析患者基本资料、病变相关因素与结直肠ESD术中出血的关系。采用单因素和多因素Logistic回归分析 ESD 术中出血的危险因素。根据筛选的危险因素构建ESD术中出血风险预测模型, 并采用ROC曲线对预测模型进行评价。结果单因素Logistic回归分析显示, 合并糖尿病(OR=2.340, P<0.05)、合并冠心病(OR=3.100, P<0.05)、病灶位于直肠(OR=3.272, P<0.05)、病灶长度越长(OR=1.093, P<0.05)、病灶宽度越宽(OR=1.057, P<0.05)、病灶面积越大(OR=1.126, P<0.05)、病灶形态为凹陷型(OR=6.128, P<0.05)、...     

Colorectal endoscopic submucosal dissection in special locations

Colorectal endoscopic submucosal dissection(ESD) is considered one of the most challenging endoscopic procedures for novice endoscopists. When compared with the stomach, the colon and rectum have a narrower tubular lumen, greater angulation at the flexures, and a thinner muscle layer. These factors make endoscopic control and maneuverability difficult. ESD of the colorectum was considered more difficult than gastric and esophageal ESD. However, with learning from the experts, practicing, and selecting an appropriate technique,most of colorectal ESD could be performed successfully. Nevertheless, some colorectal locations are extremely specialized either from unique anatomy or given unstable scope position. Accordingly, the objective of this review was to provide endoscopists with an overview of the techniques and outcomes associated with ESD at these special colorectal locations. ESD at the discussed special locations of the ileo-colo-rectum was found to be feasible, and outcomes were comparable to those of ESD performed in non-special locations of the ileocolo-rectum. Practice for skill improvement and awareness of the unique characteristics of each special location is the key to performing successful ESD.     

Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms

AIM:To investigate the risk factors for delayed bleeding following endoscopic submucosal dissection(ESD)treatment for colorectal neoplasms.METHODS:We retrospectively reviewed the medical records of 317 consecutive patients with 325 lesions who underwent ESD for superficial colorectal neoplasms at our hospital from January 2009 to June2013.Delayed post-ESD bleeding was defined as bleeding that resulted in overt hematochezia 6 h to 30d after ESD and the observation of bleeding spots as confirmed by repeat colonoscopy or a required blood transfusion.We analyzed the relationship between risk factors for delayed bleeding following ESD and the following factors using univariate and multivariate analyses:age,gender,presence of comorbidities,use of antithrombotic drugs,use of intravenous heparin,resected specimen size,lesion size,lesion location,lesion morphology,lesion histology,the device used,procedure time,and the presence of significant bleeding during ESD.RESULTS:Delayed post-ESD bleeding was found in14 lesions from 14 patients(4.3%of all specimens,4.4%patients).Patients with episodes of delayed postESD bleeding had a mean hemoglobin decrease of2.35 g/dL.All episodes were treated successfully using endoscopic hemostatic clips.Emergency surgery was not required in any of the cases.Blood transfusion was needed in 1 patient(0.3%).Univariate analysis revealed that lesions located in the cecum(P=0.012)and the presence of significant bleeding during ESD(P=0.024)were significantly associated with delayed post-ESD bleeding.The risk of delayed bleeding was higher for larger lesion sizes,but this trend was not statistically significant.Multivariate analysis revealed that lesions located in the cecum(OR=7.26,95%CI:1.99-26.55,P=0.003)and the presence of significant bleeding during ESD(OR=16.41,95%CI:2.60-103.68,P=0.003)were independent risk factors for delayed post-ESD bleeding.CONCLUSION:Location in the cecum and significant bleeding during ESD predispose patients to delayed post-procedural bleeding.Therefore,careful and additional management is recommended for these patients.     

Balloon overtube-guided colorectal endoscopic submucosal dissection

AIM: To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection (ESD) using a gastroscope.METHODS: The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy center. In preoperative evaluation of access to the lesion, difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloonguided ESD group. A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to accessibility. Colorectal ESD was performed following standard procedures. A submucosal fluid bleb was created with hyaluronic acid solution. A circumferential mucosal incision was made to marginate the lesion. The isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle knives. The success of colorectal ESD,procedural feasibility, and procedure-related complications were the main outcomes and measurements.RESULTS: The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%.En bloc excision of the lesion was successfully achieved in 13 of the 15 patients (86.7%) in the balloon overtube-guided colorectal ESD group, which was comparable to the results of the standard ESD group with better accessibility to the lesion (30/30, 100%, not statistically significant).CONCLUSION: Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.