划分层次的内镜下粘膜解剖风险:一个验证的穿孔手术前风险评分工具
Attila Ulkucu1, Mariano Laporte, Imran Khan
1Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Annals of surgery
|July 16, 2025
概括
一个新的内镜下粘膜解剖 (ESD) 风险模型预测了穿孔,提高了患者的安全性. 关键预测因素包括纤维化,早期病例和大病变大小 (>35mm).
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 医疗器械技术 医疗器械技术
背景情况:
- 内镜下粘膜解剖 (ESD) 提供了微创性结肠直肠病变的去除.
- 在ESD手术中存在穿孔的风险,导致患者患病率显著.
研究的目的:
- 开发和验证在结直肠内镜下粘膜解剖 (ESD) 期间穿孔风险的预测模型.
- 通过改善手术前风险评估来提高患者的安全性.
主要方法:
- 从2011年3月到2023年11月接受结直肠ESD的1051名患者的回顾性审查.
- 数据分层成导出和验证集;进行单变量和多变量分析.
- 用于评估模型有效性的接收器操作特征 (ROC) 曲线分析.
主要成果:
- 穿孔发生在108名 (10%) 患者身上.
- 确定了穿孔的独立预测因素:纤维化 (OR:2.67),早期手术 (OR:14.6),病变大小>35mm (OR:3.50).
- 经过验证的ESD穿孔风险评分显示了足够的性能 (AUC: 0.7078,准确率: 80.19%).
结论:
- 一个经过验证的内镜下粘膜解剖 (ESD) 穿孔风险模型已经开发出来.
- 该模型是临床医生评估患者风险的可靠工具.
- 该模型有可能改善手术前的策略和患者的治疗结果.
相关概念视频
01:22Esophageal Perforation-I: Introduction
177
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
177
01:28Esophageal Perforation-II: Clinical Manifestations and Management
151
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
151