内镜黏膜下剥离术治疗早期胃癌或胃癌前病变临床效果及并发出血影响因素分析

目的探讨内镜黏膜下剥离术治疗早期胃癌或胃癌前病变临床效果,并对其并发出血影响因素进行分析。方法回顾性分析行内镜黏膜下剥离术治疗确诊30例早期胃癌及66例胃癌前病变的临床资料,收集所有患者一般资料,观察治疗后临床效果,记录并发症、复发及生存情况,并采用单因素及多因素Logistic回归分析对内镜黏膜下剥离术治疗早期胃癌或胃癌前病变患者并发出血的影响因素进行分析。结果本组均成功切除病灶组织,整块切除96例(100%),完全切除93例(96.88%),治愈性切除90例(93.75%);并发出血22例(22.92%),穿孔3例(3.12%)。术后1年复发率为2.08%,术后1年生存率为96.88%。单因素分析结果显示,年龄≥65岁、病变部位位于胃上2/3和病灶直径≥1.5 cm的早期胃癌或胃癌前病变患者并发出血率高于年龄<65岁、病变部位位于胃下1/3和病灶直径<1.5 cm的早期胃癌或胃癌前病变患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,病变部位位于胃上2/3和病灶直径≥1.5 cm为影响内镜黏膜下剥离术治疗早期胃癌或胃癌前病变患者并发出血的独立危险因素(P<0.05)。结论内镜黏膜下剥离术治疗早期胃癌或胃癌前病变患者病灶整块切除率高,病变部位位于胃上2/3和病灶直径≥1.5 cm为影响内镜黏膜下剥离术治疗早期胃癌或胃癌前病变患者并发出血的独立危险因素。

Clinical Efficacy of Endoscopic Submucosal Dissection in the Treatment of Early Gastric Cancer or Precancerous Lesions and Influencing Factors of Concurrent Intraoperative Bleeding

Objective To explore the clinical efficacy of endoscopic submucosal dissection(ESD)in the treatment of early gastric cancer or precancerous lesions,and to analyze the influencing factors of concurrent intraoperative bleeding.Methods The clinical data of 30 patients diagnosed with early gastric cancer and 66 patients with precancerous lesions who underwent ESD in our hospital were retrospectively analyzed.General data of all patients were collected,and the clinical effect was observed after treatment.Complications,recurrence and survival were recorded.Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of concurrent bleeding in patients with early gastric cancer or precancerous lesions treated by ESD.Results There were 96 cases(100%)with en bloc resection,93 cases(96.88%)with complete resection,and 90 cases(93.75%)with curative resection.There were 22 cases(22.92%)with concurrent bleeding and 3 cases(3.12%)with perforation.The 1-year recurrence rate was 2.08%,and the 1-year survival rate was 96.88%.Univariate analysis showed that patients with early gastric cancer or precancerous lesions aged≥65 years,with lesion located on the upper 2/3 of the stomach and lesion diameter≥1.5 cm in patients with early gastric cancer or precancerous lesions had higher bleeding rate than those aged<65 years,with lesion located on the lower 1/3 of the stomach,and lesion diameter<1.5 cm(P<0.05).Multivariate Logistic analysis found that the lesion located on the upper 2/3 of the stomach,and the lesion diameter≥1.5 cm were independent risk factors affecting concurrent bleeding of patients with early gastric cancer or precancerous lesions undergoing ESD(P<0.05).Conclusion The patients with early gastric cancer or precancerous lesions undergoing ESD have a high rate of en bloc resection.The lesion located on the upper 2/3 of the stomach and the diameter of the lesion≥1.5 cm are independent risk factors that affect concurrent intraoperative bleeding of patients with early gastric cancer or precancerous lesions treated with ESD.