Gong Y, Zhang Y M, Zhu J Q, He S, Dou L Z, Liu Y, Ke Y, Liu X D, Liu Y M, Wu H R, Lyu Y, Wang G Q
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2021 Aug 23;43(8):861-865. doi: 10.3760/cma.j.cn112152-20210118-00057.
To determine the potential risk factors of delayed hemorrhage after endoscopic submucosal dissection (ESD) in patients with early gastric carcinomas or precancerous lesions. The clinical data of 637 patients with early gastric carcinomas (EGC) who treated with ESD in Department of Endoscopy at Cancer Hospital, Chinese Academy of Medical Sciences, from August 2013 to August 2019, were retrospectively analyzed. Univariate analysis and multivariate logistic analysis were conducted to evaluate the risk factors associated with delayed bleeding. A total of 699 lesions in 637 patients, of which 696 lesions were resected enbloc, the curative resection rate was 92.1% (644/699). The pathological diagnosis after ESD showed that 46 cases were low-grade intraepithelial neoplasia, 71 were high-grade intraepithelial neoplasia, and 582 were cancer. Delayed bleeding occurred in 74 lesions, while other 625 lesions without postoperative bleeding. The incidence was 10.6%. Compared with the non-bleeding group, there were statistically significant differences in the maximum length of the lesion, the gross shape of the lesion, the control of intra operative bleeding, and the operation time in the delayed bleeding group (<0.05). Multivariate logistic regression analysis showed that the maximum length of the lesion and the gross shape of the lesion were independent factors of delayed bleeding after ESD. Delayed bleeding was inclined to occur in patients with lesion size ≥3.0 cm (=1.958, 95% 1.162-3.299) and the superficial and flat lesion (=10.598, 95% 1.313-85.532) after ESD. The maximum length of the lesion and the gross shape of the lesion are independent impact factors of delayed bleeding occurring in patients with EGC and precancerous lesions after ESD. Patients with lesion size≥3 cm, or superficial flat lesion should be paid attention after ESD operation. It needs to take timely measures to prevent the very likely bleeding in order to ensure postoperative recovery and improve the quality of life for postoperative patients.
确定早期胃癌或癌前病变患者内镜黏膜下剥离术（ESD）后迟发性出血的潜在危险因素。回顾性分析2013年8月至2019年8月在中国医学科学院肿瘤医院内镜科接受ESD治疗的637例早期胃癌（EGC）患者的临床资料。进行单因素分析和多因素logistic分析以评估与迟发性出血相关的危险因素。637例患者共699个病变，其中696个病变整块切除，根治性切除率为92.1%（644/699）。ESD术后病理诊断显示低级别上皮内瘤变46例，高级别上皮内瘤变71例，癌582例。74个病变发生迟发性出血，其余625个病变无术后出血。发生率为10.6%。与未出血组相比，迟发性出血组病变最大长度、病变大体形态、术中出血控制及手术时间差异有统计学意义（<0.05）。多因素logistic回归分析显示，病变最大长度和病变大体形态是ESD术后迟发性出血的独立因素。ESD术后病变大小≥3.0 cm（=1.958，95% 1.162 - 3.299）和浅表平坦病变（=10.598，95% 1.313 - 85.532）的患者易发生迟发性出血。病变最大长度和病变大体形态是EGC和癌前病变患者ESD术后迟发性出血的独立影响因素。ESD术后，病变大小≥3 cm或浅表平坦病变的患者应予以关注。需要及时采取措施预防极有可能发生的出血，以确保术后恢复并提高术后患者的生活质量。
