| 杨 梅,王 晗,杨 敏,秦 芩,刘晓岗.内镜黏膜下剥离术治疗胃间质瘤的临床疗效及术后出血的危险因素分析[J].,2021,(10):1872-1877 |
| 内镜黏膜下剥离术治疗胃间质瘤的临床疗效及术后出血的危险因素分析 |
| Clinical Efficacy of Endoscopic Submucosal Dissection in the Treatment of Dastric Stromal Tumor and Risk Factors of Postoperative Bleeding |
| 投稿时间：2020-09-30 修订日期：2020-10-24 |
| DOI：10.13241/j.cnki.pmb.2021.10.015 |
| 中文关键词: 内镜黏膜下剥离术 胃间质瘤 术后出血 免疫功能 胃肠激素 危险因素 |
| 英文关键词: Endoscopic submucosal dissection Gastric stromal tumors Postoperative bleeding Immune function Gastrointestinal hormones Risk factors |
| 基金项目:四川省卫计委科研基金项目（19PJ130） |
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| 中文摘要: |
| 摘要 目的：探讨内镜黏膜下剥离术（ESD）治疗胃间质瘤的临床疗效及术后出血的危险因素。方法：选取2018年2月至2020年3月我院诊治的135例胃间质瘤患者作为研究对象，统计其ESD治疗后的各项临床指标，比较治疗前后患者的细胞免疫功能和胃肠激素变化，根据患者ESD治疗后是否发生出血将其进一步分为术后出血组12例和术后未出血组123例，分析胃间质瘤患者ESD术后出血的危险因素。结果：135例患者平均手术时间为（45.89±8.79）min，平均术后进食时间为（3.05±0.98）d，平均住院时间为（6.11±0.95）d，完整切除率为96.30%，术后出血发生率为8.89%，术后穿孔发生率为5.19%，术后感染发生率为9.63%。经单因素分析发现，ESD治疗胃间质瘤术后出血与高血压、糖尿病、血小板（PLT）、血清降钙素原（PCT）和C反应蛋白（CRP）有关（P<0.05）。与治疗前相比，患者治疗后CD3+、CD4+、CD4+/CD8+、血清胃动素（MTL）、胃泌素（GAS）和生长激素释放肽(Ghrelin)水平明显下降，而CD8+明显升高（P<0.05）。进一步多因素Logistic回归分析表明，胃间质瘤患者ESD术后出血的危险因素包括高血压、糖尿病、PCT＞2.73 ng/mL以及CRP＞62.19 ng/mL（P<0.05），而保护因素则为PLT＞151.38×109/L（P<0.05）。结论：ESD治疗胃间质瘤患者的疗效确切，安全性较好，但其会引起胃间质瘤患者的细胞免疫功能和胃肠激素分泌下降。同时，高血压、糖尿病、PCT＞2.73 ng/mL和CRP＞62.19 ng/mL是胃间质瘤患者ESD术后出血的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of gastric stromal tumors and the risk factors for postoperative bleeding. Methods: 135 cases of gastric stromal tumors who were diagnosed and treated in our hospital from February 2018 to March 2020 were selected as the research object, and the clinical indicators were counted. The changes of cellular immune function and gastrointestinal hormones were compared before and after treatment. According to whether bleeding occurred after ESD treatment, patients were further divided into 12 cases of postoperative bleeding group and 123 cases of postoperative non-bleeding group. The influencing factors of bleeding after ESD in patients with gastric stromal tumors were analyzed. Results: The average operation time of 135 patients was(45.89±8.79)min, the average postoperative feeding time was(3.05±0.98)d, and the average hospital stay was (6.11±0.95)d. The complete cut rate was 96.30%, the incidence of postoperative bleeding was 8.89%. The incidence of posterior perforation was 5.19%, and the incidence of postoperative infection was 9.63%. Single factor analysis showed that bleeding after ESD treatment was associated with hypertension, diabetes mellitus, platelets(PLT), serum procalcitonin (PCT) and C-reactive protein (CRP)(P<0.05). Compared with before treatment, the levels of CD3+, CD4+, CD4+/CD8+, serum motilin (MTL), gastrin (GAS) and growth hormone releasing peptide(Ghrelin) in patients after treatment decreased significantly, while the CD8+ increased significantly (P<0.05). Further multivariate Logistic regression analysis showed that the risk factors for bleeding after ESD operation included with hypertension, with diabetes mellitus, PCT>2.73 ng/mL, and CRP>62.19 ng/mL(P<0.05), while the protective factor was PLT>151.38×109/L(P<0.05). Conclusion: ESD is effective and safe in the treatment of patients with gastric stromal tumor, but it will cause decreased cellular immune function and gastrointestinal hormone secretion in patients with gastric stromal tumor. Meanwhile, hypertension, diabetes mellitus, PCT>2.73ng/mL and CRP>62.19 ng/mL are risk factors for bleeding after ESD operation in patients with gastric stromal tumor. |
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