微创医学

目的通过Meta分析评价内镜黏膜下剥离术（ESD）治疗早期胃癌（EGC）导致术后发生迟发性出血的危险因素。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库和维普数据库中关于ESD治疗EGC，并描述术后发生迟发性出血的文章，使用纽卡斯尔-渥太华量表（NOS）对检索的文献进行质量评价，于最终纳入的文献中提取相关指标的病例数据。通过RevMan5.3统计软件进行Meta分析。结果共纳入14篇文献，研究对象6 150例，发生ESD术后迟发性出血415例。Meta分析结果显示，病灶直径≥3 cm（OR=2.22, 95%CI=1.78~2.76）、病变深度位于黏膜下层（OR=7.60, 95%CI=2.89~19.99）、病灶位于胃中下1/3（OR=4.55, 95%CI=2.65~7.81）、术中明显出血（OR=6.38, 95%CI=2.84~14.30）、年龄≥60岁（OR=3.14, 95%CI=1.30~7.59）、术前活检次数≥2次（OR=6.81, 95%CI=3.05~15.22）、抗血栓类药物服用史（OR=4.65, 95%CI=2.31~9.36）、黏膜下层纤维化（OR=9.33, 95%CI=3.01~28.89）、手术时间≥60 min（OR=2.98, 95%CI=1.60~5.57）、病灶切除直径＞40 mm（OR=2.21, 95%CI=1.29~3.80），以上10个因素均为EGC患者发生ESD术后迟发性出血的危险因素。结论病灶直径≥3 cm、病变深度位于黏膜下层、病灶位于胃中下1/3、术中明显出血、年龄≥60岁、术前活检次数≥2次、抗血栓类药物服用史、黏膜下层纤维化、手术时间≥60 min、病灶切除直径＞40 mm均是EGC患者ESD术后发生迟发性出血的危险因素，临床应根据相关危险因素进行防范。

Objective To evaluate the risk factors of delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by Meta-analysis. Methods The articles about ESD treatment of EGC and description of delayed bleeding after the operation in PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database and VIP Database were searched by computer. Newcastle-Ottawa scale (NOS) was used to evaluate the quality of the retrieved literature, and the case data of related indicators were extracted from the finally included literature. Meta-analysis was carried out by RevMan5.3 statistical software. Results A total of 14 literature were included, including 6 150 research subjects, 415 cases of delayed bleeding after ESD. The results of Meta-analysis showed that lesion diameter ≥3 cm (OR=2.22, 95% CI=1.78-2.76), lesion depth located in the submucosa (OR=7.60, 95% CI=2.89-19.99), focus located in the middle and lower third of the stomach (OR=4.55, 95% CI=2.65-7.81 ), significant intraoperative bleeding (OR= 6.38, 95% CI=2.84-14.30), age ≥ 60 years old (OR=3.14, 95% CI=1.30-7.59 ), preoperative biopsy times ≥ 2 (OR=6.81, 95% CI=3.05-15.22 ), history of taking antithrombotic drugs (OR=4.65, 95% CI=2.31-9.36), submucosal fibrosis (OR=9.33, 95% CI=2.90), operation time ≥60 min(OR=2.98, 95% CI=1.60-5.57) and lesion resection diameter > 40 mm (OR=2.21, 95% CI=1.29-3.80), all of the above 10 factors are risk factors for delayed bleeding after ESD in EGC patients. Conclusion The risk factors of delayed bleeding after ESD in EGC patients are lesion diameter ≥3 cm, lesion depth located in submucosa, focus located in the middle and lower third of stomach, significant intraoperative bleeding, age ≥60 years old, preoperative biopsy times ≥2 times, history of taking antithrombotic drugs, submucosal fibrosis, operation time ≥60 min and lesion resection diameter ＞40 mm, which should be prevented according to relevant risk factors.