影响胃黏膜病变内镜黏膜下剥离术操作效率的相关因素分析

Risk factors influencing operating efficiency of endoscopic submucosal dissection for gastric mucosal lesions

摘要:

目的 探讨影响胃黏膜病变内镜黏膜下剥离术（ESD）操作效率的相关因素。 方法 2009年4月至2017年2月，空军军医大学西京消化病医院304例行ESD的胃黏膜病变病例纳入回顾性分析，以操作时间和完整切除率（R0切除率）作为ESD操作效率的主要评价指标，先后采用单变量（卡方检验）和多变量（logistic回归检验）分析影响操作时间及完整切除率的相关因素。 结果 以中位操作时间45 min作为界值进行二分类，卡方检验显示标本大小（P=0.000）、病变位置（P=0.001）、组织学类型（P=0.003）对操作时间有明显影响，进一步多变量logistic回归分析提示标本大小（≥40 mm／＜40 mm，P＜0.001，OR=3.748，95％CI：2.247～6.254）、病变位置（胃上中部／下部，P=0.001，OR=2.180，95％CI：1.318～3.606）是影响操作时间的独立危险因素。以是否R0切除进行二分类，单变量卡方检验未发现具有统计学差异的指标，进一步的多变量logistic回归分析同样未能发现影响R0切除率的独立危险因素。 结论 标本大小及病变位置是影响胃黏膜病变ESD操作效率的主要因素，在临床操作中应结合这两个因素对操作时间进行正确预估。

Abstract:

Objective To explore risk factors of influencing operating efficiency of endoscopic submucosal dissection （ESD） for gastric mucosal lesions. Methods The data of 304 cases with gastric mucosal lesion undergoing ESD in Xijing Hospital of Digestive Disease from April 2009 to February 2017 were retrospectively analyzed. The procedure time and complete resection rate （R0 resection rate） were regarded as indicators of ESD efficiency. Risk factors influencing procedure time and R0 resection rate were analyzed using Chi-square test and logistic regression. Results Using median procedure time of 45 min as the cutoff value， Chi-square test showed that specimen size （P=0.000）， lesion location （P=0.001）， and pathological type （P=0.003） affected the operation time. Further logistic regression analysis indicated that specimen size （≥40 mm／＜40 mm， P＜0.001， OR=3.748， 95％CI： 2.247-6.254） and lesion location （upper or middle 1／3 of stomach／lower 1／3 of stomach， P=0.001， OR=2.180， 95％CI： 1.318-3.606） were independent risk factors of procedure time. Using R0 resection as outcome measure， neither single nor multiple parameter analysis was statistically significant. Conclusion Specimen size and lesion location are independent risk factors influencing efficiency of gastric mucosal ESD， and could be possibly used to estimate the procedure time of ESD.