2025 年第 1 期 第 0 卷

抗栓治疗的早期胃癌患者内镜黏膜下剥离术后出血的影响因素分析

Analysis of the influencing factors of bleeding after endoscopic submucosal dissection in patients with early gastric cancer treated with antithrombotic therapy

作者：贾儒渊1 樊志惠1 王朝凤1 赵立俊2 曹文娟3 佟建丽1 徐丹丹4

英文作者：Jia Ruyuan1 Fan Zhihui1 Wang Zhaofeng1 Zhao Lijun2 Cao Wenjuan3 Tong Jianli1 Xu Dandan4

单位：1河北省张家口市第一医院消化内一科，张家口075000；2河北省衡水市第七人民医院内科，衡水052800；3河北省衡水市第四人民医院药学部，衡水053000；4河北省衡水市第七人民医院药械科，衡水053000

英文单位：1First Department of Gastroenterology Zhangjiakou First Hospital Hebei Province Zhangjiakou 075000 China; 2Department of Internal Medicine the Seventh People′s Hospital of Hengshui Hebei Province Hengshui 052800 China; 3Department of Pharmacy the Fourth People′s Hospital of Hengshui Hebei Province Hengshui 053000 China; 4Department of Pharmaceutical Equipment the Seventh People′s Hospital of Hengshui Hebei Province Hengshui 053000 China

关键词：早期胃癌；  内镜黏膜下剥离术；  抗栓治疗；  出血风险

英文关键词：Earlygastriccancer;  Endoscopicsubmucosaldissection;  Antithrombotictherapy;  Riskofbleeding

• 摘要：

• 目的  分析抗栓治疗的早期胃癌患者内镜黏膜下剥离术（ESD）后出血的影响因素。方法  回顾性分析2016年1月至2023年12月在河北省张家口市第一医院于抗栓治疗背景下接受ESD治疗的40例早期胃癌患者的临床资料，根据ESD后是否发生出血分为术后未出血组（34例）和术后并发出血组（6例）。统计抗栓治疗的早期胃癌患者ESD后出血的发生率，采用单因素和多因素Logistic回归分析方法分析出血的影响因素。结果  40例抗栓治疗的早期胃癌患者ESD后出血发生率为15.0%（6/40）。单因素分析结果显示肿瘤大小、病变深度、术中出血量与抗栓治疗的早期胃癌患者ESD后出血有关（均P＜0.05）；年龄、性别、是否合并糖尿病、病理类型与抗栓治疗的早期胃癌患者ESD后出血无关（均P＞0.05）。将单因素分析中有统计学意义的因素（病变深度、肿瘤大小、术中出血量）纳入Logistic多因素分析，结果显示肿瘤大小≥3 cm、黏膜下层病变、术中出血量≥800 ml是抗栓治疗的早期胃癌患者ESD后出血的危险因素（比值比=7.001、6.802、11.101，95%置信区间：1.502～32.592、1.464～31.615、1.931～63.852，均P＜0.05）。结论  抗栓治疗的早期胃癌患者ESD后出血受肿瘤大小、病变深度、术中出血量影响，临床须加以重视。为降低出血风险，需在术前评估和术后管理中慎重考虑抗栓治疗方案。

• Objective  To analyze the influencing factors of bleeding after endoscopic submucosal dissection (ESD) in patients with early gastric cancer treated with antithrombotic therapy. Methods   The clinical data of 40 patients with early gastric cancer who underwent ESD in the background of antithrombotic therapy in Zhangjiakou First Hospital, Hebei Province from January 2016 to December 2023 were retrospectively analyzed. According to the occurrence of bleeding after ESD, the patients were divided into non-bleeding group (34 cases) and bleeding group (6 cases). The incidence of bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy was counted. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of bleeding. Results   The incidence of bleeding after ESD was 15.0%(6/40) in 40 patients with early gastic cancer treated with antithrombotic therapy. Univariate analysis showed that tumor size, lesion depth and intraoperative blood loss were associated with postoperative bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy (all P<0.05). Age, gender, diabetes mellitus and pathological type were not associated with postoperative bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy (all P>0.05). The statistically significant factors (lesion depth, tumor size, intraoperative blood loss) in univariate analysis were included in Logistic multivariate analysis. The results showed that tumor size ≥3 cm, submucosal lesions, intraoperative blood loss ≥800 ml were risk factors for bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy（the odds ratios were 7.001, 6.802, 11.101; and the 95% confidence intervals were 1.502-32.592, 1.464-31.615, and 1.931-63.852, respectively; all P＜0.05）. Conclusion   The bleeding after ESD in patients with early gastric cancer treated with antithrombotic therapy is affected by tumor size, lesion depth and intraoperative blood loss, which should be paid attention to in clinical practice. In order to reduce the risk of bleeding, careful consideration of antithrombotic therapy should be given in the preoperative evaluation and postoperative management.