微创医学

目的探讨上消化道病变患者内镜黏膜下剥离术（ESD）术后穿孔的危险因素，并构建风险预测模型。方法回顾性分析行ESD治疗的246例上消化道病变患者的临床资料，根据术后是否发生穿孔分为穿孔组（n=28）和未穿孔组（n=218）。比较两组的临床资料，应用多因素Logistic回归分析上消化道病变患者ESD术后穿孔的危险因素，并基于危险因素构建风险预测模型。采用受试者操作特征（ROC）曲线评估模型的区分度。结果行ESD治疗的246例上消化道病变患者中，28例发生穿孔，穿孔发生率为11.38%。穿孔组女性、病变直径≥3 cm、术后病理类型为恶性、手术时间≥60 min的比例高于未穿孔组（P<0.05）。多因素Logistic回归分析结果显示，女性、病变直径≥3 cm、术后病理类型为恶性、手术时间≥60 min是上消化道病变患者ESD术后穿孔的危险因素（P<0.05），基于多因素Logistic回归分析结果构建上消化道病变患者ESD术后穿孔的风险预测模型，曲线下面积为0.826（95%CI：0.780，0.872），灵敏度和特异度分别为0.679、0.633，提示该模型具有较好的区分度。结论女性、病变直径≥3 cm、术后病理类型为恶性、手术时间≥60 min是上消化道病变患者ESD术后穿孔的危险因素，基于上述危险因素构建的风险预测模型具有一定的应用价值。

Objective To investigate the risk factors for perforation after endoscopic submucosal dissection (ESD) in patients with upper gastrointestinal lesions and to construct a risk prediction model. Methods A retrospective analysis was conducted on the clinical data of 246 patients with upper gastrointestinal lesions who underwent ESD. Patients were divided into a perforation group (n=28) and a non-perforation group (n=218) according to the occurrence of postoperative perforation. Clinical data were compared between the two groups. Multivariate Logistic regression analysis was applied to identify the risk factors for perforation after ESD in patients with upper gastrointestinal lesions, and a risk prediction model was constructed based on these risk factors. The discrimination of the model was assessed using receiver operating characteristic (ROC) curves. Results Of 246 patients with upper gastrointestinal lesions who underwent ESD, 28 developed perforation, with an incidence rate of 11.38%. The perforation group had significantly higher proportions of female patients, lesion diameter ≥3 cm, postoperative malignant pathology, and operation duration ≥60 min than the non‑perforation group (P<0.05). The results of multivariate Logistic regression analysis showed that female, lesion diameter ≥3 cm, malignant postoperative pathology, and operation duration ≥60 min were independent risk factors for perforation after ESD in patients with upper gastrointestinal lesions (P<0.05). A risk prediction model for post-ESD perforation was established based on the results of multivariate Logistic regression analysis. The area under the curve was 0.826 (95%CI: 0.780, 0.872), with a sensitivity of 0.679 and a specificity of 0.633, indicating that the model had favorable discrimination. Conclusion Female, lesion diameter ≥3 cm, postoperative malignant pathology, and operation duration ≥60 min are risk factors for perforation after ESD in patients with upper gastrointestinal lesions. The risk prediction model established based on the above risk factors has certain clinical application value.