本文選題：內(nèi)鏡下粘膜剝離術(shù) + ESD術(shù)后潰瘍�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的隨著內(nèi)鏡技術(shù)的不斷發(fā)展,內(nèi)鏡下對(duì)病灶面積測(cè)量準(zhǔn)確性的要求越來(lái)越高,本課題組與中國(guó)科學(xué)技術(shù)大學(xué)合作研制了一種新的內(nèi)鏡下病灶面積的測(cè)量方法——計(jì)算機(jī)視覺(jué)測(cè)量軟件(EAS)。本研究擬采用EAS法測(cè)量早期胃癌(EGC)ESD術(shù)后內(nèi)鏡下潰瘍面積與手術(shù)標(biāo)本面積的大小,分析EAS法體內(nèi)與體外測(cè)量面積的相關(guān)性,以驗(yàn)證計(jì)算機(jī)視覺(jué)測(cè)量軟件測(cè)量?jī)?nèi)鏡下病灶面積的可行性和準(zhǔn)確性;另外,通過(guò)計(jì)算機(jī)視覺(jué)測(cè)量軟件測(cè)量ESD術(shù)中、術(shù)后2周及術(shù)后4周潰瘍面積大小的變化,以評(píng)價(jià)不同藥物治療方案對(duì)ESD術(shù)后潰瘍愈合的影響,以期指導(dǎo)臨床用藥。方法1計(jì)算機(jī)視覺(jué)測(cè)量軟件EAS法測(cè)量?jī)?nèi)鏡下病灶面積可靠性分析收集2015年4月~2016年4月于安徽醫(yī)科大學(xué)第一附屬醫(yī)院接受胃ESD術(shù)的癌前病變或早期胃癌患者。利用EAS法測(cè)量ESD術(shù)后內(nèi)鏡下潰瘍面積及手術(shù)標(biāo)本面積的大小,記錄結(jié)果,采用合適的統(tǒng)計(jì)學(xué)方法分析其相關(guān)性。2 EAS法評(píng)估PPI聯(lián)合黏膜保護(hù)劑對(duì)ESD術(shù)后潰瘍愈合的影響接受胃ESD手術(shù)癌前病變或早期胃癌患者,排除術(shù)后追加手術(shù)或放療患者,利用隨機(jī)數(shù)字表法分為藥物聯(lián)合組和PPI組。藥物聯(lián)合組及PPI組均于術(shù)后三天給予艾司奧美拉唑40 mg Bid靜脈滴注,術(shù)后第四天,藥物聯(lián)合組給予艾司奧美拉唑20 mg口服Bid×4周+替普瑞酮50mg口服Tid×4周;PPI組單獨(dú)給予艾司奧美拉唑20 mg口服Bid×4周。兩組患者術(shù)中及術(shù)后2周、4周進(jìn)行胃鏡檢查同時(shí)EAS法測(cè)量潰瘍面積,評(píng)價(jià)潰瘍愈合情況及潰瘍分期。結(jié)果1 EAS法測(cè)量?jī)?nèi)鏡下病灶面積可靠性分析本試驗(yàn)共納入ESD手術(shù)患者64例,利用EAS法所測(cè)ESD術(shù)后內(nèi)鏡下潰瘍面積平均值為1510.50±484.22 mm2;術(shù)后標(biāo)本面積平均值為961.28±356.99mm2。ESD術(shù)后潰瘍面積明顯大于手術(shù)標(biāo)本面積,經(jīng)統(tǒng)計(jì)學(xué)分析發(fā)現(xiàn)兩者呈正相關(guān),相關(guān)系數(shù)r=0.978,為顯著性相關(guān)。2 EAS法評(píng)估PPI聯(lián)合黏膜保護(hù)劑對(duì)ESD術(shù)后潰瘍愈合的影響(1)一般情況將最終納入本試驗(yàn)的64例患者隨機(jī)分為藥物聯(lián)合組和PPI組,藥物聯(lián)合組33例,年齡48-78歲,平均年齡66.88±6.82歲,男:女1.75:1;PPI組31例,年齡46-79歲,平均年齡66.32±7.33歲,男:女1.38:1。藥物聯(lián)合組及PPI組患者均隨訪(fǎng)至術(shù)后4周,術(shù)中及術(shù)后均未追加手術(shù)或放療。藥物聯(lián)合組及PPI組患者年齡、性別、病變性質(zhì)、病變部位、創(chuàng)面大小均無(wú)統(tǒng)計(jì)學(xué)差異。(2)ESD術(shù)后遲發(fā)性出血及穿孔的發(fā)生情況藥物聯(lián)合組無(wú)遲發(fā)性出血,PPI組1例發(fā)生遲發(fā)性出血,內(nèi)鏡下成功止血,兩組術(shù)后出血率無(wú)明顯統(tǒng)計(jì)學(xué)差異(P=0.484)。兩組均未見(jiàn)術(shù)中及術(shù)后穿孔情況。(3)ESD術(shù)后潰瘍面積愈合情況術(shù)后2周,兩組的潰瘍面積均有明顯縮小,經(jīng)統(tǒng)計(jì)學(xué)分析,兩組潰瘍面積差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后4周藥物聯(lián)合組潰瘍面積顯著小于PPI組,有統(tǒng)計(jì)學(xué)差異(P0.05)。(4)ESD術(shù)后潰瘍分期的觀察術(shù)后2周,藥物聯(lián)合組12例A1期,18例A2期,3例H1期;PPI組16例A1期,13例A2期,2例H1期,潰瘍分期無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后4周,兩組均以愈合期潰瘍?yōu)橹?藥物聯(lián)合組6例H1期,20例H2期,7例S1期;PPI組16例H1期,12例H2期,3例S1期,藥物聯(lián)合組潰瘍愈合級(jí)別高于PPI組,有統(tǒng)計(jì)學(xué)差異(P0.05)。(5)ESD術(shù)后潰瘍愈合的影響因素分析通過(guò)單因素分析,病變部位、病理類(lèi)型及初始潰瘍面積對(duì)ESD術(shù)后潰瘍愈合有影響(P0.05)。通過(guò)進(jìn)一步多因素逐步Logistic回歸分析表明,初始潰瘍面積及病變部位與ESD術(shù)后潰瘍愈合顯著相關(guān)(P0.01)。結(jié)論通過(guò)對(duì)ESD術(shù)后內(nèi)鏡下潰瘍面積及手術(shù)標(biāo)本面積的比較,結(jié)果顯示兩者呈正相關(guān),相關(guān)系數(shù)r為0.978,為顯著性相關(guān)。EAS法可用于測(cè)量體內(nèi)病灶面積,具較好的可行性及準(zhǔn)確性。ESD是治療消化道癌前病變及早癌的可靠、有效的手段。ESD術(shù)后醫(yī)源性潰瘍面積較大,需要盡快促進(jìn)潰瘍愈合,預(yù)防出血、穿孔等并發(fā)癥的發(fā)生。本研究采用不同藥物治療方案治療ESD術(shù)后潰瘍,觀察ESD術(shù)后潰瘍愈合速度及愈合質(zhì)量,結(jié)果顯示PPI聯(lián)合黏膜保護(hù)劑療法優(yōu)于PPI單獨(dú)療法,提示PPI聯(lián)合粘膜保護(hù)劑能更有效促進(jìn)潰瘍愈合,減少術(shù)后并發(fā)癥的發(fā)生率。采用EAS法可以準(zhǔn)確測(cè)量ESD術(shù)后潰瘍面積,有利于對(duì)潰瘍愈合情況的評(píng)估及藥物治療效果的客觀評(píng)價(jià)。
[Abstract]:Objective with the continuous development of endoscopy, the requirement for the accuracy of focus area measurement is becoming more and more high. Our team and University of Science & Technology China have developed a new method of measuring the area of endoscopes - computer vision measurement software (EAS). This study is to use EAS to measure early gastric cancer (EGC) ESD The size of the area of the endoscopic ulcer area and the area of the surgical specimen was used to analyze the correlation between the EAS method and the measured area in vitro, in order to verify the feasibility and accuracy of the computer vision measurement software to measure the area of the lesion under endoscopy. In addition, the changes of the size of the ulcer area 2 weeks after the operation and 4 weeks after the operation were measured by the computer vision software. To evaluate the effect of different drug treatments on the healing of ulcer after ESD, to guide clinical medication. Method 1 computer vision software EAS method was used to measure the reliability of the lesion area under endoscopy in the First Affiliated Hospital of Medical University Of Anhui in April, April 2015, and to collect the precancerous lesions or early gastric cancer patients who received gastric ESD surgery in the First Affiliated Hospital of Medical University Of Anhui. EAS method was used to measure the area of endoscopy ulcers and the size of the area of the surgical specimen after ESD, and the results were recorded. A suitable statistical method was used to analyze the correlation.2 EAS method to evaluate the effect of PPI combined with mucosal protective agent on the healing of the ulcer after ESD, and to accept the precancerous or early gastric cancer patients in the gastric ESD operation, excluding the postoperative additional operation or radiotherapy. The drug combined group and the PPI group were given the intravenous drip of esomeprazole 40 mg Bid three days after the operation, and the drug combined group was given Bid x 4 weeks + tiprreone 50mg orally Tid for 4 weeks, and the group PPI group was given esomeprazole 20 mg mouth alone on the fourth day after the operation. Taking Bid for 4 weeks. Two groups of patients were performed intraoperative and 2 weeks, 4 weeks after 2 weeks, 4 weeks after gastroscopy, and EAS method was used to measure the area of ulcers. The results of the ulcer healing and the ulcer staging were evaluated. The results of the reliability analysis of the lesion area under the 1 EAS method were included in the 64 cases of the patients with ESD operation, and the mean value of the endoscopic ulcer area under the EAS method was 1510.5. 0 + 484.22 mm2; the average area of specimen area after operation was 961.28 + 356.99mm2.ESD and the area of the ulcer was obviously larger than the area of the surgical specimen. It was found that there was a positive correlation between them and the correlation coefficient r=0.978, which was a significant correlation.2 EAS method to evaluate the effect of PPI combined mucosal protective agent on the ulcer healing after ESD operation (1) the general situation would be finally included. 64 patients in this experiment were randomly divided into drug combination group and PPI group, 33 cases of drug combination group, age 48-78 years old, average age 66.88 + 6.82 years old, male: female 1.75:1; group PPI 31 cases, age 46-79 years, average age 66.32 + 7.33 years old, male: female 1.38:1. drug combination group and PPI group were followed up 4 weeks, both intraoperative and postoperative no additional operation or release. Treatment. There was no significant difference in age, sex, pathological nature, lesion location and size of wound in the combination group and PPI group. (2) late bleeding and perforation after ESD had no delayed bleeding, 1 cases in group PPI had delayed hemorrhage, and endoscopy was performed to stop bleeding, and there was no significant difference between the two groups after operation (P=0.48 4) there was no intraoperative and postoperative perforation in the two groups. (3) the ulcer area after ESD after operation was 2 weeks after operation, and the area of the ulcer area in the two groups was significantly reduced. The two groups of ulcer areas were not statistically significant (P0.05), and the ulcer surface of the combination group was significantly smaller than that in the group PPI after 4 weeks (P0.05). (4) the ulceration of ESD after operation. 2 weeks after surgery, 12 cases of A1, 18 A2, 3 H1, 16 A1, 13 A2, 2 H1 stages in group PPI were not statistically different (P0.05). In the two group, 4 weeks after operation, 6 cases of H1, 20 H2, S1 period, PPI group 16 cases, 12 cases The level of ulcer healing was higher than that of the PPI group (P0.05). (5) the influence factors of ulcer healing after ESD were analyzed by single factor analysis, the lesion site, pathological type and initial ulcer area had an influence on the healing of ulcers after ESD (P0.05). The initial ulcer area and lesion site were analyzed by step by step Logistic regression analysis. There was a significant correlation between the healing of ulcers after ESD (P0.01). Conclusion the results showed that there was a positive correlation between the area of endoscopic ulcers and the area of the surgical specimen after ESD. The correlation coefficient r was 0.978, and the significant correlation.EAS method could be used to measure the area of the lesion in the body, and it was a good and accurate.ESD for the treatment of the precancerous lesions of the digestive tract. Early cancer is reliable, effective means of.ESD postoperative iatrogenic ulcer area is larger. It is necessary to promote ulcer healing, prevent bleeding, perforation and other complications as soon as possible. This study uses different drug treatment regimens to treat the ulcer after ESD, and observe the healing speed and healing quality of the ulcer after ESD, and the results show that PPI combined with mucosal protective agent therapy is excellent. PPI alone therapy suggests that PPI combined with mucosal protective agents can promote the healing of ulcers and reduce the incidence of postoperative complications. The use of EAS can accurately measure the area of the ulcer after ESD, and is beneficial to the evaluation of the healing of ulcers and the objective evaluation of the effect of the drug treatment.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.2

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本文編號(hào)：2039549