幽门螺杆菌除菌治疗后短期内对胃内镜黏膜下剥离术中出血的影响分析

Effect of Helicobacter pylori eradication therapy on intraoperative bleeding during gastric endoscopic submucosal dissection in a short term

摘要:

目的 探究幽门螺杆菌（Helicobacter pylori，HP）根除后短期内对早期胃癌内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）中出血的影响。方法 回顾性分析2021年9月至2023年9月在上海市东方医院因早期胃癌行ESD治疗的患者资料，将HP现症感染患者纳入现症感染组，将除菌治疗后10周内且除菌成功的患者纳入除菌后短期组，分析两组患者内镜、病理和临床资料，比较术中出血发生情况。结果 共纳入345例患者，其中，现症感染组156例，除菌后短期组189例。相比现症感染组，除菌后短期组术中出血率降低［6.3%（12/189）比12.8%（20/156）， χ２ =4.253，P=0.039］，手术时间减少［（29±9）min比（38±14）min，t=2.667，P=0.008］。病变部位亚组分析发现，胃上1/3处病灶除菌治疗后短期内术中出血发生率较现症感染患者降低［12.5%（5/40）比32.1%（9/28）， χ２ =3.887，P=0.049］，而胃中1/3［5.4%（2/37）比10.0%（3/30）， χ２ =0.506，P=0.477］和胃下1/3［4.5%（5/112）比8.2%（8/98）， χ２ =1.231，P=0.267］处病灶除菌后与现症感染的术中出血发生率差异无统计学意义。结论 HP除菌治疗后短期内可以有效减少ESD术中出血发生，显著减少手术时间。HP现症感染的早期胃癌患者在行ESD前应给予杀菌治疗，尤其是位于胃上1/3的病灶。

Abstract:

Objective To investigate the short-term effect of Helicobacter pylori (HP) eradication on intraoperative bleeding during endoscopic submucosal dissection (ESD) for early gastric cancer. Methods Patients who underwent ESD for early gastric cancer in Shanghai East Hospital from September 2021 to September 2023 were retrospectively analyzed for endoscopic, pathological and clinical data. The patients with current HP infection were included in the current infection group, and those who underwent eradication therapy within 10 weeks and successfully eradicated were included in the short-term after eradication group. The occurrence of intraoperative bleeding was compared. Results A total of 345 patients were analyzed, with 156 in the current infection group and 189 in the short-term after eradication group. Compared with the current infection group, short-term after eradication group was effective in reducing the intraoperative bleeding rate [6.3% (12/189) VS 12.8% (20/156), χ2 =4.253, P=0.039] and significantly reduced the duration of operation (29±9 min VS 38±14 min, t=2.667, P=0.008). Intraoperative bleeding was significantly reduced in short-term after eradication group in lesions of the upper 1/3 of the stomach [12.5% (5/40) VS 32.1% (9/28), χ2 =3.887, P=0.049], while there were no significant differences in intraoperative bleeding between the current infection group and the short-term after eradication group in lesions of the middle 1/3 [5.4% (2/37) VS 10.0% (3/30), χ2 =0.506, P=0.477] and lower 1/3 [4.5% (5/112) VS 8.2% (8/98), χ2 =1.231, P=0.267] of the stomach. Conclusion HP eradication therapy can effectively reduce intraoperative bleeding in ESD and significantly reduce the duration of operation in a short-term. For individuals with early gastric cancer and HP infection, undergoing eradication therapy before ESD is recommended, particularly for lesions situated in the upper 1/3 of the stomach.