CAJ | 학술논문

目的：分析内镜黏膜下剥离术（ESD）治疗胃黏膜下肿瘤（GSMT）的并发症与安全性，并探讨并发症的相关危险因素。方法对101例 ESD 治疗的胃黏膜下肿瘤患者的临床资料进行回顾性分析，观察其并发症发生与处理情况；对术中并发出血、穿孔的危险因素行单因素卡方检验与多因素 Logistic 逐步回归分析。结果101例患者的肿瘤均一次性完整切除，术中出血31例、穿孔8例，未发生延迟性出血及穿孔。术中出血、穿孔患者均保守治疗成功，未中转外科手术治疗。术中出血独立危险因素为：贲门-胃底、异位胰腺、肿瘤直径；术中穿孔的可能危险因素为：肿瘤直径、操作时间、病变深度、贲门-胃底。结论ESD 治疗胃黏膜下肿瘤并发症少，其并发症多可通过内镜下及其他内科手段成功治疗，是治疗胃黏膜下肿瘤安全可靠的方法。肿瘤位于贲门胃底、病理为异位胰腺、肿瘤直径较大的胃黏膜下肿瘤行 ESD 治疗发生术中出血风险较大；病变位于贲门-胃底、来源于固有肌层、直径较大、手术时间较长者发生穿孔的风险可能更大。
목적：분석내경점막하박리술（ESD）치료위점막하종류（GSMT）적병발증여안전성，병탐토병발증적상관위험인소。방법대101례 ESD 치료적위점막하종류환자적림상자료진행회고성분석，관찰기병발증발생여처리정황；대술중병발출혈、천공적위험인소행단인소잡방검험여다인소 Logistic 축보회귀분석。결과101례환자적종류균일차성완정절제，술중출혈31례、천공8례，미발생연지성출혈급천공。술중출혈、천공환자균보수치료성공，미중전외과수술치료。술중출혈독립위험인소위：분문-위저、이위이선、종류직경；술중천공적가능위험인소위：종류직경、조작시간、병변심도、분문-위저。결론ESD 치료위점막하종류병발증소，기병발증다가통과내경하급기타내과수단성공치료，시치료위점막하종류안전가고적방법。종류위우분문위저、병리위이위이선、종류직경교대적위점막하종류행 ESD 치료발생술중출혈풍험교대；병변위우분문-위저、래원우고유기층、직경교대、수술시간교장자발생천공적풍험가능경대。
ABSTRACT:Objective To analyze the complications and safety of endoscopic submucosal dissec-tion (ESD)for gastric submucosal tumor (GSMT),and to investigate the risk factors for the complications.Methods Clinical data of 101 patients who underwent ESD for GSMT were ana-lyzed retrospectively.The complications and treatments of patients were investigated.Further-more,the risk factors for intraoperative hemorrhage and perforation were analyzed by univariate chi-square test and multivariate stepwise Logistic regression analysis.Results All patients under-went en bloc resection at the first treatment.Among the 101 patients,31 had intraoperative hem-orrhage and 8 had intraoperative perforation.No patients had delayed hemorrhage and perfora-tion.Patients with intraoperative hemorrhage and perforation underwent successful conservative treatment,and no patients were converted to surgical treatment.The cardia-fundus,ectopic pan-creas and tumor diameter were risk factors for intraoperative hemorrhage.The tumor diameter, operation time,lesion depth and cardia-fundus were risk factors for intraoperative perforation. Conclusion The ESD results in fewer complications in the treatment of GSMT,and most of the complications can be successfully treated by endoscopic therapy or other internal medicine proce-dures.Therefore,ESD is a safe and reliable treatment for GSMT.The cardia-fundus location,ec-topic pancreas,and larger tumor diameter are the high risk factors for intraoperative hemorrhage during ESD treatment for GSMT.The cardia-fundus location,source from intrinsic muscle layer, larger tumor diameter,and longer operation time are the high risk factors for intraoperative perfo-ration during ESD treatment for GSMT.