结直肠肿瘤内镜下黏膜下剥离术后出血的危险因素
Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors.
作者信息
Okamoto Kazuki, Watanabe Tomohiro, Komeda Yoriaki, Kono Tatsuya, Takashima Kouta, Okamoto Ayana, Kono Masashi, Yamada Mitsunari, Arizumi Tadaaki, Kamata Ken, Minaga Kosuke, Yamao Kentaro, Nagai Tomoyuki, Asakuma Yutaka, Takenaka Mamoru, Sakurai Toshiharu, Matsui Shigenaga, Nishida Naoshi, Chikugo Takaaki, Kashida Hiroshi, Kudo Masatoshi
机构信息
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
出版信息
Oncology. 2017;93 Suppl 1:35-42. doi: 10.1159/000481228. Epub 2017 Dec 20.
BACKGROUND
Colonoscopic removal of adenomatous polyps or early cancer prevents death from colorectal cancer. Endoscopic submucosal dissection (ESD), which enables endoscopists to perform en bloc resection of flat or depressed colorectal tumors >20 mm, has recently been introduced and become a standard procedure in Japan. Although postoperative bleeding (POB) is a major complication associated with ESD, risk factors for POB have not been fully identified.
METHODS
A total of 451 patients (509 lesions) who underwent colorectal ESD were retrospectively analyzed to identify clinical parameters associated with POB.
RESULTS
POB occurred in 14 patients, and 7 of them had received antithrombotic therapy before ESD. Uni- and multivariate analyses revealed that antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions.
CONCLUSION
Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.
背景
结肠镜切除腺瘤性息肉或早期癌症可预防结直肠癌死亡。内镜黏膜下剥离术（ESD）能使内镜医师对直径大于20mm的平坦或凹陷性结直肠肿瘤进行整块切除，该技术最近已被引入并在日本成为标准手术。尽管术后出血（POB）是与ESD相关的主要并发症，但POB的危险因素尚未完全明确。
方法
对451例行结直肠ESD的患者（509个病变）进行回顾性分析，以确定与POB相关的临床参数。
结果
14例患者发生POB，其中7例在ESD前接受了抗血栓治疗。单因素和多因素分析显示，抗血栓治疗和直肠肿瘤位置与结直肠ESD术后POB密切相关。接受肝素桥接治疗（HBT）以替代抗血栓治疗的患者POB发生率高于未接受HBT的患者。7例接受抗血栓治疗的患者中有4例（57.1%）直肠病变发生POB。
结论
抗血栓治疗和直肠病变导致结直肠ESD术后POB发生率更高。
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