摘要
目的分析上消化道黏膜下肿瘤(SMT)经过内镜全层切除术(EFTR)治疗后发生并发症的相关危险因素。方法本研究采用回顾性观察性研究方法。EFTR的适应证为:(1)起源于固有肌层的SMT,呈部分腔外生长或浸润至固有肌层深部;(2)SMT直径<5 cm;(3)内镜黏膜下剥离术或内镜黏膜切除术中发现肿瘤瘤体与浆膜层紧密粘连、无法分离。纳入术前经过超声内镜或CT评估确认为起源于黏膜层以下的上消化道肿瘤并成功行EFTR的SMT患者。排除临床资料不完整者。根据上述标准回顾性分析2016年1月至2022年1月苏州大学附属第一医院消化科上消化道SMT行EFTR的154例患者的临床资料,观察SMT患者行EFTR术后发生并发症情况,包括迟发性穿孔、迟发性出血和术后感染(含电凝综合征),并分析EFTR术后出现并发症的危险因素。结果154例患者中,33例(21.4%)发生并发症,包括迟发性出血3例(1.9%),迟发性穿孔2例(1.3%),术后感染28例(18.2%)。1例出血为重度并发症(因并发症住院10 d以上)。单因素分析显示,肿瘤长径>15 mm、手术时间>90 min、缺损闭合方式为荷包缝合、大体标本长径≥20 mm与EFTR术后并发症的发生有关(均P<0.05)。多因素logistic回归分析显示,手术时间>90 min(OR=6.252,95%CI:2.530~15.446,P<0.001)和肿瘤长径>15 mm(OR=4.843,95%CI:1.985~11.817,P=0.001)是EFTR术后并发症的独立危险因素。EFTR术后感染的独立危险因素为手术时间>90 min(OR=4.993,95%CI:1.964~12.694,P=0.001)和采用荷包缝合方式闭合缺损(OR=7.142,95%CI:1.953~26.123,P=0.003)。结论当肿瘤长径>15 mm或手术时间>90 min时,接受EFTR手术的上消化道SMT患者术后发生并发症的风险更高,需重视其术后的观察。
Objective To analyze the risk factors for complications of endoscopic full-thickness resection(EFTR)of upper gastrointestinal submucosal tumors(SMTs).Methods This was a retrospective observational study.The indications for EFTR included:(1)SMTs originating from the muscularis propria layer and growing out of the cavity or infiltrating the deep part of the muscularis propria layer;(2)SMTs diameter<5 cm;and(3)tumor identified as closely adherent to the serous layer during endoscopic submucosal dissection or endoscopic mucosal resection.This study included patients with SMTs originating from the muscularis propria layer in upper digestive tract,diagnosed preoperatively by endoscopic ultrasonography or computed tomography,who were successfully treated with EFTR.Those with incomplete clinical data were excluded.The clinical data of 154 patients with upper gastrointestinal SMTs who underwent EFTR at the Department of Gastroenterology,First Affiliated Hospital of Soochow University from January 2016 to January 2022 were retrospectively analyzed.Post-EFTR complications(such as delayed perforation,delayed bleeding,and postoperative infection,including electrocoagulation syndrome)were monitored and the risk factors for them were analyzed.Results Among the 154 study patients,33(21.4%)developed complications,including delayed bleeding in three(1.9%),delayed perforation in two(1.3%),and postoperative infection in 28(18.2%).One patient with bleeding was classified as having a major complication(hospitalized for more than 10 days because of complication).According to univariate analysis,complication was associated with tumor diameter>15 mm,operation time>90 minutes,defect closure method(purse string suture),and diameter of resected specimen≥20 mm(all P<0.05).Multivariate logistic regression analysis showed that operation time>90 minutes(OR=6.252,95%CI:2.530–15.446,P<0.001)and tumor diameter>15 mm(OR=4.843,95%CI:1.985–11.817,P=0.001)were independent risk factors for complications after EFTR in patients with upper gastrointestinal SMTs.The independent risk factors for postoperative infection in these patients were operation time>90 minutes(OR=4.993,95%CI:1.964–12.694,P=0.001)and purse string suture(OR=7.142,95%CI:1.953–26.123,P=0.003).Conclusion Patients with upper gastrointestinal SMTs undergoing EFTR with tumor diameter>15 mm or operation time>90 minutes have a significantly increased risk of postoperative complications.Postoperative monitoring is important for these patients with SMTs.
作者
倪柳菁
朱文鑫
邹宸焘
许郭婷
王超
吴爱荣
Ni Liujing;Zhu Wenxin;Zou Chentao;Xu Guoting;Wang Chao;Wu Airong(Department of Gastroenterology,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Gastroenterology,Kunshan Third People's Hospital,Kunshan,Jiangsu 215300,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2023年第4期365-371,共7页
Chinese Journal of Gastrointestinal Surgery
关键词
黏膜下肿瘤
上消化道
内镜全层切除术
并发症
危险因素
Submucosal tumors,upper gastrointestinal
Endoscopic full-thickness resection
Complications
Risk factors
