Analysis of the risk factors of postoperative complications after endoscopic submucosal dissection / 中国医师杂志

ABSTRACT

Objective To investigate the risk factors of postoperative complications of delayed hemorrhage,perforation and digestive tract stenosis after endoscopic submucosal dissection (ESD).Methods The complete data of 793 patients with digestive tract disease who underwent the endoscopic submucosal dissection in the Department of Digestive Surgery in our hospital from January 2011 to December 2014 were retrospectively analyzed.All of the patients were divided into delayed hemorrhage group (n =67) and nonbleeding group (n =726);perforation group (n =47) and non-perforation group (n =746);and digestive tract stenosis group (n =38) and non-stenosis group (n =755).The clinical basic data,lesion related data,and operation related data were independent risk factor and analyzed by single factor analysis and Logistic multiple factor regression analysis.Results The incidence of delayed bleeding,perforation and stenosis in patients with ESD were 8.45％,5.93％,and 4.79％,respectively.The results of single factor analysis:the risk factors for delayed bleeding were long-term use of anticoagulant drugs,gastric sinus disease,lesion diameter,and lesion excision (P ＜ 0.05).The risk factors for postoperative perforation were the diameter of the lesion and the time of operation (P ＜ 0.05).The risk factors of digestive tract stenosis were the esophageal lesions,the diameter of the lesion,and the depth of the lesion to the intrinsic muscle layer (P ＜ 0.05).The results of multi factor Logistic regression analysis:the risk ranking of risk factors for delayed bleeding was gastric antrum occurrence lesion ＞ lesions graded resection ＞ long-term use of anticoagulants ＞ lesion diameter (≥5 mm).The risk ranking of risk factors for perforation was operation time (≥90 mm) ＞ lesion diameter (≥5 mm).The risk ranking of risk factors for digestive tract stenosis was esophageal lesion ＞ lesion diameter (≥ 5 mm) ＞ lesions depth to the muscularis propria.Conclusions For long-term anticoagulation,gastric antrum and fractional resection lesions of patients should pay attention to delayed bleeding.Patients with long operation time are easy to cause postoperative perforation.For long-term anticoagulation,gastric antrum and fractional resection lesions of patients should pay attention to delayed bleeding.