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内镜黏膜下剥离术治疗结直肠肿瘤时并发穿孔的因素预测

发布日期:2014-1-29 12:40:10 文章来源:Endoscopy 作者次数:1265
     内镜黏膜下剥离术治疗结直肠肿瘤时并发穿孔的因素预测
    E.  S.  Kim1, K.  B.  Cho1, K.  S.  Park1, K.  I.  Lee1, B.  K.  Jang1, W.  J.  Chung1, J.  S.  Hwang1
    1韩国大邱启明大学医学院,胃肠病学和肝病研究所内科
    背景与目的:
    尽管众所所周知结肠穿孔是内镜黏膜下剥离术治疗结肠瘤的主要并发症之一,但穿孔的因素预测还没被完全评估。这个研究的目的是确定在结肠内镜黏膜下剥离术时与穿孔发生有关的种种因素
    方法:
    记录一批正接受内镜黏膜下剥离术治疗的肠瘤患者的情况,并把记录做回顾性分析。而可能的风险因素包括年龄,性别,伴存疾病,用药史,手术时间,手术切除方法,肿瘤大小,位置,大体形态,纤维化的存在,病理表现。那名在穿孔发生的情况下,分析与住院时间相关的因素。
    结果:
    研究的108例患者有108种病变损害(男性68例;平均年龄为63.01 ± 10.71岁)。平均肿瘤尺寸大小为27.59 ± 10.10 mm(范围:8 - 53 mm)大肠侧向发育型肿瘤是最常见类型(75 %),其次是突出类型肿瘤。程序时间为61.95 ± 41.90分(范围:5-198分)。完整切除的病变损害有85例(78.7 %)。发生穿孔的有22例(20.4 %)。多因素分析,证实肿瘤尺寸大小[比值比 (OR): 1.084; 95 % 置信区间 (CI): 1.015 - 1.158; P = 0.017]与纤维化存在(OR: 4.551; 95 %CI: 1.092 - 18.960; P = 0.037)是穿孔的独立危险因素。所有这些穿孔案例有非外科手术治疗。年龄较低,腹痛的患者似乎是被要求延长住院时间。
    结论:在结肠内镜黏膜下剥离术治疗期间,肿瘤尺寸和纤维化是产生并发症的重要因素。低年龄和腹痛发展情况对穿孔患者的医疗进程有预测作用。
     
    Original article
    Endoscopy 2011; 43(7): 573-578
    DOI: 10.1055/s-0030-1256339

    © Georg Thieme Verlag KG Stuttgart · New York
     
    Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors
     
    E.  S.  Kim1, K.  B.  Cho1, K.  S.  Park1, K.  I.  Lee1, B.  K.  Jang1, W.  J.  Chung1, J.  S.  Hwang1
    1 Department of Internal Medicine, Institute of Gastroenterology and Hepatology, Keimyung University School of Medicine, Daegu, South Korea

    Background and aim: Although perforation of the colon is known as one of the main complications of endoscopic submucosal dissection (ESD) for colorectal tumor management, factors predictive of perforation have not been fully evaluated. This study aimed to determine the factors associated with perforation during colorectal ESD.

    Methods: Patients with colorectal tumors undergoing ESD were enrolled and their records were reviewed retrospectively. Age, sex, co-morbidity, medication history, procedure time, resection method, tumor size, location, gross morphology, the presence of fibrosis, and histologic findings were included as possible risk factors. In the cases where perforation had occurred, factors associated with the duration of hospitalization were analyzed.

    Results: One hundred eight lesions in 108 patients were eligible for inclusion in the study (68 patients were male; mean patient age was 63.01 ± 10.71 years). Mean tumor size was 27.59 ± 10.10 mm (range: 8 - 53 mm). Laterally spreading tumor was the most common type (75 %), followed by the protruding type (25 %). Procedure time was 61.95 ± 41.90 minutes (range: 5 - 198 minutes). Complete en bloc resection was achieved for 85 lesions (78.7 %). Perforation occurred in 22 patients (20.4 %). Multivariate analysis confirmed that tumor size [odds ratio (OR): 1.084; 95 % confidence interval (CI): 1.015 - 1.158; P = 0.017] and the presence of fibrosis (OR: 4.551; 95 %CI: 1.092 - 18.960; P = 0.037) were independent risk factors for perforation. All cases of perforation were managed with nonsurgical treatment. Younger age and abdominal pain appeared to be related to prolonged hospitalization.

    Conclusion: Tumor size and fibrosis are important factors related to complications during colorectal ESD. Younger age and development of abdominal pain can predict the hospital course in patients with perforation after ESD.

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