食管射频消融术后发热的影响因素分析

Risk factors for fever after esophageal radiofrequency ablation

摘要:

目的 探讨食管内镜下射频消融术（radiofrequency ablation，RFA）后患者发热的独立危险因素。方法 2016年1月—2021年4月，因早期食管癌就诊于长海医院消化内科，且病变范围超过食管3/4环周的51例病例纳入病例对照研究。患者均行RFA治疗，按术后是否发热分成发热组（n=15）和未发热组（n=36），主要收集患者一般情况、消化道肿瘤家族史、病变长度、病变范围、消融能量和消融次数用于单因素分析，其中P<0.1的变量再进一步纳入多因素Logistic回归分析探究RFA术后发热的独立危险因素。结果 单因素分析发现，病变长度（t=-3.89，P<0.001）、病变范围（χ2=11.52，P=0.001）和消融能量（P=0.001）在2组间差异有统计学意义。Pearson相关性显示，病变长度与病变环周长度存在明显正相关（r=0.71，P<0.001），而病变范围由病变环周长度决定，因此最终将病变长度和消融能量这两个变量纳入Logistic回归方程。Logistic回归分析结果显示，食管病变长度每增加1 cm，患者发生RFA术后发热的风险是前者的1.21倍（95%CI：1.01～1.43，P=0.037）；术中使用12 J消融能量者，发生RFA术后发热的风险是使用10 J消融能量者的0.43倍（95%CI：0.22～0.85，P=0.015）。结论 病变长度和消融能量是导致食管RFA术后发热的独立危险因素。长节段早期食管癌者更易发生RFA术后发热，术中使用低消融能量者更易发生RFA术后发热。

Abstract:

Objective To investigate the independent risk factors for fever after endoscopic radiofrequency ablation (RFA). Methods From January 2016 to April 2021, 51 patients with early esophageal cancer, who were treated with RFA in the Department of Gastroenterology, Changhai Hospital and whose lesion range exceeded 3/4 of the circumference of esophagus, were included in the case-control study. Patients were divided into fever group (n=15) and non-fever group (n=36) according to whether they had fever after operation. The general condition of patients, family history of gastrointestinal tumors, lesion length, lesion range, ablation energy and ablation times were mainly collected for univariate analysis. The variables with P<0.1 were further included in multivariate logistic regression analysis to explore the independent risk factors for fever after RFA. Results Univariate analysis showed that the lesion length (t=-3.89, P<0.001), lesion range (χ2=11.52, P=0.001) and ablation energy (P=0.001) were significantly different between the two groups. Pearson correlation showed that there was a significant positive correlation between lesion length and lesion circumference (r=0.71, P<0.001), and the lesion range was determined by the lesion circumference length. Therefore, the two variables of lesion length and ablation energy were finally included in the logistic regression analysis. Logistic regression analysis showed that the risk of fever after RFA was 1.21 times as high as that before when the length of esophageal lesions increased by 1 centimeter (95%CI: 1.01-1.43, P=0.037). The risk of fever after RFA using 12 J ablation energy was 0.43 times as high as that using 10 J ablation energy (95%CI: 0.22-0.85, P=0.015). Conclusion Lesion length and ablation energy are independent risk factors for fever after esophageal RFA. Patients with long segment early esophageal cancer and using low ablation energy are more likely to have fever after RFA.