CAJ | 학술논문

目的探讨消化道黏膜或黏膜下病变经内镜下黏膜剥离术后发热情况及其相关危险因素.方法回顾分析自2009年11月至2012年4月间270例因消化道黏膜或黏膜下病变行内镜下黏膜剥离术(ESD)患者的相关临床、内镜及病理资料,统计分析以下相关因素:(1)患者相关因素:如性别、年龄、糖尿病史、呼吸系统等其他慢性病史,吸烟史、过敏史、术前预防性使用抗生素情况、白细胞计数.(2)病变相关因素:病变位置、病变大小、浸润深度.(3)操作相关因素:麻醉方式、是否整块切除、术中出血量、操作时间、是否穿孔.结果纳入研究者总共有病例270例,病变275处.56例患者发生ESD术后发热,发生率为20.7％,其中31例(55.4％)在术后24h内发生,发热持续时间为1～8d,平均(1.7±1.4)d,通过单因素及多因素分析,术中穿孔(OR值7.121,95％ CI:1.740～29.151)及病变位于食管(OR值0.181,95％ CI:0.091～0.361)是ESD术后发热的相关危险因素.结论术中穿孔及病变位于食管是ESD术后发热的危险因素,对于食管病变及术中出现穿孔的病例,应警惕术后发热,并予相应处理.
목적 탐토소화도점막혹점막하병변경내경하점막박리술후발열정황급기상관위험인소.방법 회고분석자2009년11월지2012년4월간270례인소화도점막혹점막하병변행내경하점막박리술(ESD)환자적상관림상、내경급병리자료,통계분석이하상관인소:(1)환자상관인소:여성별、년령、당뇨병사、호흡계통등기타만성병사,흡연사、과민사、술전예방성사용항생소정황、백세포계수.(2)병변상관인소:병변위치、병변대소、침윤심도.(3)조작상관인소:마취방식、시부정괴절제、술중출혈량、조작시간、시부천공.결과 납입연구자총공유병례270례,병변275처.56례환자발생ESD술후발열,발생솔위20.7％,기중31례(55.4％)재술후24h내발생,발열지속시간위1～8d,평균(1.7±1.4)d,통과단인소급다인소분석,술중천공(OR치7.121,95％ CI:1.740～29.151)급병변위우식관(OR치0.181,95％ CI:0.091～0.361)시ESD술후발열적상관위험인소.결론 술중천공급병변위우식관시ESD술후발열적위험인소,대우식관병변급술중출현천공적병례,응경척술후발열,병여상응처리.
Objective To determine the risk factors associated with fever after endoscopic dissection of mucosal/submucosal lesions in gastrointestinal tract.Methods Clinical,endoscopic and pathological data of 275 lesions in 270 ESD patients from November 2009 and April 2012 were collected.The following factors associated with fever were analyzed:(1) patient-related factors:age,sex,concomitant diseases including diabetes mellitus,chronic disease of respiratory system,history of smoking,history of allergy,white blood cell count before ESD,antibiotic prophylaxis.(2)lesion-related factors:location,size,infiltration depth.(3) procedure-related factors:anesthesia method,en-bloc resection,operation time,perforation during ESD.Results A total of 275 lesions in 270 ESD patients,56 patients developed fever after ESD,with the rate of 20.7％.Among them,31 cases (55.4％) occurred within 24 hours after ESD.Duration of fever is 1-8 (1.7 ± 1.4) days.Univariate and multivariate analysis revealed that perforation during ESD (OR:7.121,95％ CI:1.740-29.151) and esophageal lesion (OR:0.181,95％ CI:0.091-0.361) were risk factors for fever after ESD.Conclusion Intraoperative perforation and esophageal lesions were risk factors for fever after ESD.Therefore precautions should be taken for patients with high risk factors during ESD procedure.