Cai Ren-Song, Yang Wei-Zhong, Cui Guang-Rui
Digestive Endoscopy Department, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China.
World J Gastrointest Surg. 2023 Jan 27;15(1):94-104. doi: 10.4240/wjgs.v15.i1.94.
Endoscopic submucosal dissection (ESD) is a treatment for early gastric cancer with the advantages of small invasion, fewer complications, and a low local recurrence rate. However, there is a high risk of complications such as bleeding and perforation, and the operation time is also longer. ESD operation time is closely related to bleeding and perforation.
To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning, early identification, and prevention of complications.
We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021. The baseline data, clinical features, and endoscopic and pathological characteristics of patients were collected. The multivariate linear regression model was used to investigate the influencing factors of ESD operation time. Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.
The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815% of ESD operation time when other influencing factors remained unchanged. The operation time increased by 3.766% or 10.247% if the lesion was mixed or concave. The operation time increased by 4.417% if combined with an ulcer or scar. The operation time increased by 3.692% if combined with perforation. If infiltrated into the submucosa, it increased by 2.536%. Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion, lesion morphology, and ESD operation time were independent influencing factors for delayed hemorrhage after ESD. Patients with lesion ≥ 3.0 cm (OR = 3.785, 95%CI: 1.165-4.277), lesion morphology-concave (OR = 10.985, 95%CI: 2.133-35.381), and ESD operation time ≥ 60 min (OR = 2.958, 95%CI: 1.117-3.526) were prone to delayed hemorrhage after ESD.
If the maximum diameter of the lesion in patients with early gastric cancer is ≥ 3.0 cm, and the shape of the lesion is concave, or accompanied by an ulcer or scar, combined with perforation, and infiltrates into the submucosa, the ESD operation will take a longer time. When the maximum diameter of the lesion is ≥ 3.0 cm, the shape of the lesion is concave in patients and the operation time of ESD takes longer time, the risk of delayed hemorrhage after ESD is higher.
内镜黏膜下剥离术（ESD）是一种治疗早期胃癌的方法，具有侵袭小、并发症少、局部复发率低等优点。然而，存在出血和穿孔等并发症的高风险，且手术时间也较长。ESD手术时间与出血和穿孔密切相关。
探讨与ESD手术时间及术后延迟出血相关的影响因素，为早期规划、早期识别及预防并发症提供参考。
基于海南医学院第二附属医院2019年1月至2021年12月520例早期胃癌患者的临床资料进行回顾性研究。收集患者的基线数据、临床特征以及内镜和病理特征。采用多元线性回归模型研究ESD手术时间的影响因素。进行Logistic回归分析以评估术后延迟出血的影响因素。
ESD手术时间的多因素分析显示，在其他影响因素不变的情况下，最大病变直径可影响ESD手术时间的8.815%。若病变为混合型或凹陷型，手术时间分别增加3.766%或10.247%。若合并溃疡或瘢痕，手术时间增加4.417%。若合并穿孔，手术时间增加3.692%。若浸润至黏膜下层，手术时间增加2.536%。ESD术后延迟出血的多因素分析显示，病变最大直径、病变形态及ESD手术时间是ESD术后延迟出血的独立影响因素。病变≥3.0 cm（OR = 3.785，95%CI：1.165 - 4.277）、病变形态为凹陷型（OR = 10.985，95%CI：2.133 - 35.381）以及ESD手术时间≥60 min（OR = 2.958，95%CI：1.117 - 3.526）的患者ESD术后易发生延迟出血。
早期胃癌患者若病变最大直径≥3.0 cm，病变形状为凹陷型，或伴有溃疡或瘢痕，合并穿孔，且浸润至黏膜下层，ESD手术时间会更长。当病变最大直径≥3.0 cm，病变形状为凹陷型且ESD手术时间较长时，ESD术后延迟出血的风险更高。
