本文選題：內(nèi)鏡下黏膜剝離術(shù)　切入點(diǎn)：術(shù)中穿孔　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討胃黏膜病變經(jīng)內(nèi)鏡下黏膜剝離術(shù)(endoscopic submucosal dissection,ESD)發(fā)生術(shù)中穿孔和術(shù)后出血情況,并分析相關(guān)危險(xiǎn)因素。方法對2013年12月至2016年10月,于青島大學(xué)附屬醫(yī)院因胃黏膜病變行內(nèi)鏡下黏膜剝離術(shù)患者的臨床、內(nèi)鏡及病理資料進(jìn)行核對記錄。排除不符合納入要求的患者資料,對符合納入要求的患者手術(shù)相關(guān)資料進(jìn)行統(tǒng)計(jì),并分析以下相關(guān)因素:1.患者相關(guān)因素:性別、年齡、是否伴發(fā)高血壓,糖尿病,及其他慢性病史(慢性肺炎、慢性腎病、肝硬化等)、既往是否服用抗凝藥等。2.病變相關(guān)因素:病變直徑、病變部位、病變數(shù)量、內(nèi)鏡下分型、表面伴有潰瘍或瘢痕情況、是否合并幽門螺旋桿菌(Helicobacter Pylori,HP)感染及病理類型等。3.操作相關(guān)因素:手術(shù)時(shí)間、手術(shù)者經(jīng)驗(yàn)、病變切除情況(整塊或分塊)、術(shù)中放置鈦夾或縫合情況。采用SPSS19.0統(tǒng)計(jì)軟件,對上述相關(guān)因素進(jìn)行單因素及多因素分析,由此確定ESD術(shù)中穿孔及術(shù)后出血的相關(guān)危險(xiǎn)因素。結(jié)果1.共有18例患者(含18處病變)發(fā)生ESD術(shù)中穿孔,均為微小穿孔,術(shù)中穿孔發(fā)生率為3.6%。2.病變位置、病變直徑在穿孔組與未穿孔組兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05),進(jìn)一步多因素Logistic回歸分析顯示,病變直徑≥2 cm(OR值6.87,95%CI為1.66-28.44),病變位于賁門胃底(OR值18.31,95%CI為4.31-78.04)是術(shù)中穿孔的獨(dú)立危險(xiǎn)因素。3.患者性別、年齡、是否伴有合并癥、既往服用抗凝藥、是否伴有HP感染、是否伴有潰瘍或瘢痕、病理類型、內(nèi)鏡下分型及是否整塊切除等在在穿孔組與未穿孔組兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.共有12例患者(含12處病變)發(fā)生ESD術(shù)后出血,發(fā)生率為2.4%,所有發(fā)生出血或穿孔的患者均經(jīng)內(nèi)鏡下保守治療成功后出院,無死亡病例發(fā)生。5.病變直徑在出血組與未出血組兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05),進(jìn)一步多因素Logistic回歸分析顯示,病變直徑≥4cm(OR值8.98,95%CI為1.59-50.53)是術(shù)后出血的獨(dú)立危險(xiǎn)因素。6.患者性別、年齡、是否伴有合并癥、抗凝藥物服用史、是否伴有HP感染、是否伴有潰瘍或瘢痕、病理類型、內(nèi)鏡下分型、病變部位及是否整塊切除等在出血組與未出血組兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.胃黏膜病變位于賁門胃底、直徑≥2cm是ESD發(fā)生術(shù)中穿孔的獨(dú)立危險(xiǎn)因素。2.病變直徑≥4cm是術(shù)后出血的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to investigate the incidence of intraoperative perforation and postoperative bleeding in endoscopic submucosal dissection of gastric mucosal lesions, and to analyze the risk factors. The clinical, endoscopic and pathological data of patients undergoing endoscopic mucosal dissection due to gastric mucosal lesions in the affiliated Hospital of Qingdao University were checked and recorded. The data of patients who did not meet the requirements of inclusion were excluded. Analyze the following factors: sex, age, hypertension, diabetes, and other chronic diseases (chronic pneumonia, chronic nephropathy, and other chronic diseases), and analyze the following related factors: sex, age, hypertension, diabetes, and other chronic disease history (chronic pneumonia, chronic nephropathy, chronic pneumonia, chronic nephropathy, chronic pneumonia, chronic nephropathy). Liver cirrhosis, whether or not to take anticoagulants, etc. 2. Pathological changes related factors: lesion diameter, lesion location, number of lesions, endoscopic classification, surface with ulcer or scar, Whether Helicobacter pylori Helicobacter pylori (Helicobacter pylori) infection and pathological type, etc. 3. Operation related factors: time of operation, experience of operation, resection of lesion (whole or divided into pieces, placement of titanium clip or suture during operation). SPSS19.0 statistical software was used. Univariate and multivariate analysis was carried out to determine the risk factors for perforation during and after ESD. Results 1. There were 18 patients (including 18 lesions) with ESD perforation, all of which were microperforation. 2. The incidence of perforation during operation was 3.6%. The location of lesion and the diameter of lesion were significantly different between the perforation group and the non-perforation group (P 0.05). The further multivariate Logistic regression analysis showed that there was no significant difference between the two groups. The CI of lesion 鈮，

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