中国实用外科杂志

中国实用外科杂志

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结直肠内镜黏膜下剥离术后电凝综合征临床特征及危险因素分析

孙    迪，齐志鹏，钟芸诗，时    强，蔡世伦，李    冰，陈    涛，姚礼庆，徐美东，周平红   

  1. 复旦大学附属中山医院内镜中心  上海消化内镜诊疗工程技术研究中心，上海200032
  • 出版日期:2018-06-01 发布日期:2018-06-21

  • Online:2018-06-01 Published:2018-06-21

摘要：

目的    探讨结直肠内镜黏膜下剥离术（ESD）术后电凝综合征（PEECS）的临床特点和危险因素，为ESD围手术期处理提供证据。方法    回顾性分析2008年1月至2014年7月复旦大学附属中山医院收治的412例经内镜黏膜下剥离术治疗结直肠黏膜下肿瘤的病人。分析病人的性别、年龄、病变大小、位置和起源等因素与PEECS的关系。结果    28例（6.8%）病人并发结直肠ESD术后PEECS。单因素分析显示肿瘤大小、肿瘤位置和肿瘤起源是危险因素。多因素Logistic回归分析结果显示肿瘤直径（＜20 mm vs. ≥20 mm）、肿瘤位置（结肠 vs. 直肠）和肿瘤起源（黏膜层或黏膜下层 vs. 固有肌层）为PEECS发生的独立危险因素（P＜0.05）。结论    肿瘤直径≥20 mm、肿瘤位于结肠和肿瘤起源于固有肌层是ESD切除结直肠黏膜下肿瘤术后病人并发PEECS的独立危险因素。对于存在这些危险因素的病人，术后应予严密观察和谨慎的围手术期护理。

关键词: 内镜黏膜下剥离术, 结直肠黏膜下肿瘤, 电凝综合征

Abstract:

Clinical features and risk factors of coagulation syndrome after endoscopic submucosal dissection        SUN Di, QI Zhi-peng, ZHONG Yun-shi, et al. Endoscopy Center, Zhongshan Hospital, Fudan University; Shanghai Center of Engineering Technology, Diagnosis and Treatment in Endoscopy，Shanghai 200032,China
Corresponding author: ZHONG Yun-shi, E-mail：zhong.yunshi@zs-hospital.sh.cn
Abstract    Objective    To investigate the clinical features and risk factors of post-ESD electrocoagulation syndrome （PEECS） in patients with colorectal submucosal tumors (SMTs). Methods    The medical records of 412 patients underwent ESD for colorectal SMTs at Endoscopy Center of Zhongshan Hospital，Fudan University between January 2008 and July 2014 were analyzed retrospectively.The correlation between PEECS and age，gender，tumor size，tumor location and tumor origin were analyzed. Results    Among 412 patients，PEECS was developed in 28 patients （6.8%）. Univariate analysis showed that tumor size，tumor location and tumor origin were related to PEECS. By multivariate analysis，tumor size ≥20mm，location in colon and origin from the muscularis propria were the risk factors for PEECS（P＜0.05）. Conclusion    Tumor size≥20mm，location in colon and origin from the muscularis propria are the risk factors for PEECS. Therefore，postoperative close observation and careful additional management are recommended for those patients.

Key words: endoscopic submucosal dissection, colorectal submucosal tumor, post-ESD electrocoagulation syndrome