胃黏膜剥离术后溃疡愈合的危险因素分析

摘要

[目的]分析胃黏膜病变内镜黏膜下剥离术（ESD ）后溃疡愈合的危险因素。[方法]对胃黏膜病变行ESD的连续性患者120例、术后溃疡愈合的危险因素进行单因素和多因素非条件Logistic回归分析；根据是否伴有幽门螺杆菌（ H p ）感染将患者分为 H p阳性组、H p阴性组，比较2组患者的临床和内镜资料，以及ESD后4周、8周的溃疡大小、分期及瘢痕愈合率。[结果]对ESD后8周溃疡愈合的单因素Logistic回归分析结果表明，术前长期使用非甾体类抗炎药（NSAID ）、病变部位、局部合并溃疡或瘢痕、伴有 H p感染、术后创面大小与溃疡瘢痕愈合显著相关；随后的多因素 Logistic回归分析表明，仅术后创面大小、伴有 H p感染与溃疡瘢痕愈合显著负相关（ P＜0.05）。ESD后4周时，Hp阴性组的溃疡面积显著小于 Hp 阳性组（P＜0.05）；Hp阴性组的S1期愈合率高于H p阳性组，但2组差异无统计学意义。ESD后8周时，H p阴性组的溃疡面积显著小于 H p阳性患者，而且S1期瘢痕愈合率显著高于 H p阳性组（P＜0.05）。进一步对不同时间的溃疡分期进行分析，术后4周、8周 H p阴性组的的整体溃疡愈合质量均显著高于同期 H p阳性组（P＜0.05）。[结论]H p感染是胃黏膜病变ESD后溃疡愈合的危险因素，而且影响了ESD后医源性溃疡的愈合速度和愈合质量。%Objective]To evaluate the risk factors of ulcer healing induced by gastric endoscopic submu‐cosal dissection(ESD). [Methods]A retrospective analysis was carried out on consecutive patients with gas‐tric disease who had undergone gastric ESD. The risk factors of ESD‐induced ulcer healing were analyzed by using univariate and multivariate Logistic regression. All patients were divided into two groups accord‐ing to whether Helicobacter pylori(H p)infection. The ulcer size ,stage and scarring rate at 4 wk and 8 wk after ESD were compared in the two groups. [Results]Univariate Logistic regression analysis showed that continued use of non‐steroidal anti‐inflammatory drugs(NSAID) ,tumor location ,combined with ulcer or scar ,H p infection and initial ulcer size were significantly related with the ulcer healing rate (P<0.05). In the following multivariate Logistic regression ,only H p infection and initial ulcer size were significantly re‐lated with the ulcer healing rate(P<0.05).Retrospective analysis showed that ,the ulcer size in Hp nega‐tive patients at 4‐wk was significantly smaller than that in H p positive patients(P<0.05). There was no difference between the scarring rate in two groups at 4‐wk.Comparing with the H p positive patients ,the H p negative patients had a significantly smaller ulcer size and a significantly higher scarring rate at 8‐wk.And the level and quality of the ulcer healing in the Hp negative patients were significantly higher than those in the H p positive patients at 4‐wk and 8‐wk(P<0.05). [Conclusion]H p infection is a risk factor of gastric ESD induced ulcer. H p infection could decrease the scarring rate and the quality of ESD induced iat‐rogenic ulcer healing.