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胃肿瘤内镜黏膜下剥离术后延迟穿孔的临床因素

Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms.

作者信息

Yamamoto Yoshinobu, Nishisaki Hogara, Sakai Hideki, Tokuyama Nagahiro, Sawai Hiroaki, Sakai Aya, Mimura Takuya, Kushida Saeko, Tsumura Hidetaka, Sakamoto Takeshi, Miki Ikuya, Tsuda Masahiro, Inokuchi Hideto

机构信息

Department of Gastroenterology, Hyogo Cancer Center, Hyogo 673-8558, Japan.

Department of Internal Medicine, Kaibara hospital, Hyogo 669-3395, Japan.

出版信息

Gastroenterol Res Pract. 2017;2017:7404613. doi: 10.1155/2017/7404613. Epub 2017 Aug 15.

DOI:10.1155/2017/7404613
PMID:28894466
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5574302/
Abstract

BACKGROUND

Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD) for early gastric neoplasm (EGN). The aim of this study was to clarify clinical factors related to delayed perforation after ESD.

METHODS

A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation.

RESULTS

Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%). All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation ( < 0.01). Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s) than at nonperforated points (3.5 s) in five patients.

CONCLUSIONS

Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

摘要

背景

延迟穿孔是早期胃肿瘤（EGN）内镜黏膜下剥离术（ESD）一种罕见但严重的并发症。本研究的目的是阐明ESD术后延迟穿孔相关的临床因素。

方法

2000年1月至2015年12月期间，我院共有1158例连续的患者、1199个EGN接受了ESD。采用单因素分析确定与延迟穿孔相关的临床病理因素。此外，通过比较延迟穿孔患者穿孔点和未穿孔点止血所需的烧灼时间。

结果

在1158例连续接受ESD的1199个EGN患者中，有5例发生延迟穿孔（0.42%）。所有病例均在ESD后24小时内确诊，并经保守治疗康复。单因素分析显示，胃上部的位置是与延迟穿孔最显著相关的因素（<0.01）。5例患者穿孔点止血所需的烧灼时间（9秒）明显长于未穿孔点（3.5秒）。

结论

胃上部的位置是EGN行ESD术后与延迟穿孔最显著相关的危险因素。此外，延迟穿孔似乎与过度电灼止血有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/218b996d617f/GRP2017-7404613.007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/576146814e24/GRP2017-7404613.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/f4c389b837d9/GRP2017-7404613.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/4534094c2bf2/GRP2017-7404613.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/218b996d617f/GRP2017-7404613.007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/576146814e24/GRP2017-7404613.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/f4c389b837d9/GRP2017-7404613.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/4534094c2bf2/GRP2017-7404613.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/164b/5574302/218b996d617f/GRP2017-7404613.007.jpg

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