摘要
目的探讨抗栓药物对内镜黏膜下剥离术(ESD)术后出血的影响。方法选取2016年1月至2020年12月期间接受ESD治疗的患者纳入本研究,分析抗栓药物对ESD术后出血的影响。结果肝素替代治疗(HR)、多重抗栓药物、切除标本直径超过38 mm、病灶位于胃上1/3均为术后出血的危险因素,连续使用阿司匹林不是术后出血的危险因素。在单抗血栓药物组,持续组与停药组的出血率比较,差异无统计学意义(4.5%vs.4.4%,P=1.000);在多种抗血栓药物组,持续组出血率高于停药组(66.7%vs.14.8%,P=0.020)。结论ESD术后出血风险与抗栓药物种类、组合、使用方法相关。在抗血栓药物ASA停用或连续使用的情况下,可行胃ESD术。使用多种抗栓药物或HR会增加ESD术后出血的风险。
Objective To investigate the effect of antithrombotic drugs on postoperative bleeding after endoscopic submucosal dissection(ESD).Methods Patients who received ESD from January 2016 to December 2020 were included in this study.The effect of antithrombotic drugs on bleeding after ESD was analyzed.Results Heparin replacement therapy(HR),multiple antithrombotic drugs,the diameter of excised specimen exceeding 38 mm,and the focus located in the upper third of the stomach were all risk factors for postoperative bleeding.Continuous administration of aspirin was not a risk factor for postoperative bleeding.In the monotherapy antithrombotic drug group,there was no significant difference in bleeding rate between the continuous group and the drug withdrawal group(4.5%vs.4.4%,P=1.000).In the multi-antithrombotic drug group,the bleeding rate in the continuous group was higher than that in the drug withdrawal group(66.7%vs.14.8%,P=0.020).Conclusion The risk of bleeding after ESD is related to the type,combination and use of antithrombotic drugs.Gastric ESD is feasible when ASA,an antithrombotic drug,is discontinued or used continuously.The use of multiple antithrombotic drugs or HR will increase the risk of bleeding after ESD.
作者
陈佳园
陈怡
陈成帷
张益光
CHEN Jiayuan;CHEN Yi;CHEN Chengwei;ZHANG Yiguang(Department of Gastroenterology,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Zhejiang Chinese Medical University,Wenzhou 325000,China;Department of Orthopedics,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)
出处
《中国现代医生》
2021年第34期105-108,共4页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2017KY629)
浙江省温州市科技计划项目(Y20180640)。
关键词
抗栓药物
内镜黏膜下剥离术
术后出血
危险因素
药物管理
Antithrombotic drugs
Endoscopic submucosal dissection
Postoperative bleeding
Risk factor
Drug management
