摘要
目的回顾性分析不同病变部位和年龄段患者行内镜黏膜下剥离术(ESD)术后并发症的发生特点.方法共纳入2011年1月至2017年10月在浙江大学附属第一医院行ESD治疗的1688例(1799例次ESD术)患者的病历资料.病变部位包括食管232例次,胃1225例次,十二指肠9例次,结肠152例次,直肠181例次.伴基础疾病患者500例,行508次ESD,无基础疾病患者1188例.将例数较多的胃、食管及结直肠部位的患者,分为<45岁组202例,45~59岁组643例,60~74岁组744例,≥75岁组99例,分析比较4组不同病变部位不同ESD术后并发症发生率.统计学比较采用卡方检验.结果自2011年至2017年,ESD术后并发症发生率分别为20.0%(8/40)、18.3%(21/115)、15.9%(35/220)、10.7%(31/291)、11.3%(40/355)、10.7%(41/384)和10.7%(42/394),差异无统计学意义(χ2=10.432,P=0.064).进一步分析发现,2011年至2013年ESD术后并发症发生率高于2014年至2017年[17.1%(64/375)比10.8%(154/1424)],差异有统计学意义(χ2=10.895,P<0.01).<45岁、45~59岁、60~74岁和≥75岁组病变部位在食管的患者分别有4.5%(1/22)、23.6%(17/72)、24.4%(31/127)和5例(共11例)发生并发症.<45岁、45~59岁、60~74岁和≥75岁组病变部位在胃的患者分别有19.2%(28/146)、14.2%(68/479)、15.8%(85/539)和16.4%(10/61)发生并发症.<45岁、45~59岁、60~74岁和≥75岁组病变部位在结肠的患者分别有1例(共12例)、3.4%(2/58)、10.9%(7/64)和5例(共18例)发生并发症.<45岁、45~59岁、60~74岁和≥75岁组病变部位在直肠的患者分别有3.3%(1/30)、10.4%(7/67)、19.4%(14/72)和2例(共12例)发生并发症.病变部位在食管和结肠的不同年龄段患者ESD术后并发症发生率比较,差异均有统计学意义(χ2=10.894、13.540,P=0.012、0.004).伴基础疾病和无基础疾病患者并发症发生率比较[14.6%(74/508)比12.5%(149/1188)],差异无统计学意义(χ2=1.278,P=0.258).结论ESD术后并发症的发生与病变部位和年龄等因素密切相关.对于老年患者,尤其是病变位于食管和结肠的患者,临床需提高关注程度,加强临床操作水平,以减少并发症的发生.
Objective To retrospectively analyze the characteristics of postoperative complications of endoscopic submucosal dissection(ESD)in patients of different age groups with lesions at different locations.Methods From January 2011 to October 2017,at The First Affiliated Hospital of Zhejiang University,clinical data of 1688 patients who received ESD treatment(1799 ESD operations)were collected.The lesions were located in the esophagus(n=232),stomach(n=1225),duodenum(n=9),colon(n=152)and rectum(n=181).There were 500 patients(508 ESD operations)with underlying diseases,and 1188 patients without underlying diseases.Most patients with lesions at stomach,esophagus and colon rectum,and these patients were divided into four age groups<45 years(n=202),4559 years(n=643),6074 years(n=744),and≥75 years(n=99).The postoperative complications rates of ESD in different lesions among four age groups were compared.Chi-square test was performed for statistical analysis.Results From 2011 to 2017,the complication rates after ESD were 20.0%(8/40),18.3%(21/115),15.9%(35/220),10.7%(31/291),11.3%(40/355),10.7%(41/384)and 10.7%(42/394),respectively,and the difference was not statistically significant(χ2=10.432,P=0.064).Further analysis revealed that the complication rates after ESD between 2011 and 2013 was significantly higher than that between 2014 and 2017(17.1%,64/375 vs.10.8%,154/1424);and the difference was statistically significant(χ2=10.895,P<0.01).The complication rates of patients with lesions in the esophagus of<45 years group,4559 years group,6074 years group and≥75 years group were 4.5%(1/22),23.6%(17/72),24.4%(31/127)and five cases(totally 11 cases).The complication rates of patients with lesions in the stomach of<45 years group,4559 years group,6074 years group and≥75 years group were 19.2%(28/146),14.2%(68/479),15.8%(85/539)and 16.4%(10/61).The complication rates of lesions in the colon of<45 years group,4559 years group,6074 years group and≥75 years group were one case(totally 12 cases),3.4%(2/58),10.9%(7/64)and five cases(totally 18 cases),respectively.The complication rates of lesions in the rectum of<45 years group,4559 years group,6074 years group and≥75 years group were 3.3%(1/30),10.4%(7/67),19.4%(14/72)and two cases(totally 12 cases),respectively.There were significant differences in complication rates between different age groups with lesions in the esophagus(χ2=10.894,P=0.012)and the colon(χ2=13.540,P=0.004).In addition,the complication rates of patients with underlying diseases and without underlying diseases were 14.6%(74/508)and 12.5%(149/1188),respectively,and there was no statistically significant difference(χ2=1.278,P=0.258).Conclusions The postoperative complications of ESD is closely associated with lesion location and age.For elderly patients,especially those with lesions in the esophagus and colon,paying more attention and strengthening the clinical practice can effectively reduce the incidence of complications.
作者
陈伟琴
胡明富
季峰
Chen Weiqin;Hu Mingfu;Ji Feng(Department of Gastroenterology,The First Affiliated Hospital of Zhejiang University,Hangzhou 310002,China;Department of Gastroenterology,Ninghai First Hospital,Ningbo 315600,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2019年第7期473-477,共5页
Chinese Journal of Digestion
关键词
手术后并发症
出血
内镜黏膜下剥离术
穿孔
Postoperative complications
Hemorrhage
Endoscopic submucosal dissection
Perforation
