风险因素,临床过程和在结直肠内镜下粘膜解剖后延迟穿孔的管理:一项大型多中心研究
Naohisa Yoshida1, Ryohei Hirose2, Ken Inoue3
1Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan. naohisa@koto.kpu-m.ac.jp.
Digestive diseases and sciences
|March 11, 2025
概括
在结直肠内镜下粘膜切割 (ESD) 后的延迟穿孔 (DP) 在0.39%的病例中发生. 严重的纤维化和长时间的手术增加了DP风险,但内镜闭合可以预防手术.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 结肠直肠手术 结肠直肠手术
背景情况:
- 延迟穿孔 (DP) 是结直肠内镜下粘膜解剖 (ESD) 后的一个重要并发症.
- 了解DP的风险因素和临床过程对于改善患者的治疗结果至关重要.
- 本研究调查了结直肠ESD后DP的发病率,风险因素和管理策略.
研究的目的:
- 分析结直肠内镜下粘膜切割 (ESD) 后与延迟穿孔 (DP) 相关的发生率和危险因素.
- 检查临床过程,包括DP的发病时间和管理策略.
- 评估不同治疗方式的有效性,包括内镜干预和手术.
主要方法:
- 来自13所机构的4632个连续结直肠ESD病例 (2006年1月至2024年5月) 的回顾性审查.
- 鉴定和分析DP病例,评估患者和病变特征 (例如瘤大小,位置,纤维化).
- 多变量分析以确定PD的显著风险因素,并评估治疗结果.
主要成果:
- DP发生在18例 (0.39%的发病率).
- 重要风险因素包括严重纤维化 (OR 4.61) 和长时间的手术时间 (OR 1.01). 完全关闭与DP风险 (OR 0.12) 相反相关.
- 虽然61.1%的DP病例需要手术,但内镜闭合在83.3%的病例中是成功的.
结论:
- 结直肠ESD后延迟穿孔 (DP) 的发生率很低,但影响很大.
- 严重的纤维化和延长的手术时间是DP的关键风险因素.
- 内镜管理,包括闭合,在预防DP病例的手术方面显示出希望.
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