抗栓药物与早期胃癌内镜黏膜下剥离术后迟发性出血的关联性研究

Association between antithrombotic drugs and delayed bleeding after endoscopic submucosal dissection for early gastric cancer

摘要:

目的 分析抗栓药物与早期胃癌内镜黏膜下剥离术（ESD）术后迟发性出血的关联性。方法 选取2023年1月—2026年1月在邯郸市第一医院接受ESD治疗的早期胃癌患者99例，根据术后是否发生迟发性出血分为迟发性出血组（12例）和未出血组（87例）。比较两组临床资料，并采用多因素逐步Logistic回归分析早期胃癌ESD术后迟发性出血的影响因素。结果 迟发性出血组与未出血组性别构成、年龄、合并糖尿病率、合并高血压率、合并心血管疾病率、病理类型构成、抗栓药物单药使用率、单独血小板使用率、单独抗凝药使用率、多种抗血小板药物使用率、抗血小板和抗凝药使用率、单独抗血小板药物使用率、单独抗凝药使用率、抗血小板和抗凝药使用率比较，差异均无统计学意义（P >0.05）。迟发性出血组浸润深度为黏膜下层占比、抗血小板药物使用率、抗栓药物多药使用率、多种抗血小板药物使用率均高于未出血组（P <0.05）。多因素逐步Logistic回归分析结果显示，浸润深度为黏膜下层［O^R =7.150（95% CI：1.562，32.732）］、抗血小板药物使用［O^R =6.340（95% CI：1.366，29.417）］、抗凝药物使用［O^R =8.947（95% CI：1.148，69.714）］、抗栓药物使用多药［O^R =11.003（95% CI：1.290，93.883）］均是早期胃癌ESD术后迟发性出血的危险因素（P <0.05）。结论 抗血小板药物、抗凝药及抗栓药物多药联合使用均是早期胃癌ESD术后迟发性出血的独立危险因素，且风险会随药物种类增加而升高；浸润深度达黏膜下层亦显著增加迟发性出血的风险。

Abstract:

Objective To analyze the association between antithrombotic drugs and delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer.Methods Clinical data of 99 patients with early gastric cancer who underwent ESD in our hospital from January 2023 to January 2026 were collected. Patients were categorized into a delayed bleeding group (n = 12) and a non-bleeding group (n = 87) based on the occurrence of postoperative delayed bleeding. Clinical characteristics were compared between the two groups, and multivariate logistic regression analysis was performed to identify risk factors for delayed bleeding after ESD.Results There were no statistically significant differences between the delayed bleeding group and the non-bleeding group in terms of sex distribution, age, prevalence of diabetes mellitus, prevalence of hypertension, prevalence of cardiovascular disease, pathological type composition, single antithrombotic drug use rate, single antiplatelet drug use rate, single anticoagulant use rate, multiple antiplatelet drug use rate, combined antiplatelet and anticoagulant use rate, single antiplatelet drug use rate alone, single anticoagulant use rate alone, and combined antiplatelet and anticoagulant use rate (P > 0.05). Statistically significant differences were observed between the two groups in invasion depth, antiplatelet drug use rate, anticoagulant use rate, multiple antithrombotic drug use rate, and multiple antiplatelet drug use rate (P < 0.05). The delayed bleeding group had a higher proportion of submucosal invasion, a higher antiplatelet drug use rate, a higher multiple antithrombotic drug use rate, and a higher multiple antiplatelet drug use rate than the non-bleeding group. Multivariate analysis showed that submucosal invasion [O^R = 7.150 (95% CI: 1.562, 32.732) ], antiplatelet drug use [O^R = 6.340 (95% CI: 1.366, 29.417) ], anticoagulant drug use [O^R = 8.947 (95% CI: 1.148, 69.714) ], and use of multiple antithrombotic drugs [O^R = 11.003 (95% CI: 1.290, 93.883) ] were independent risk factors for delayed bleeding after ESD for early gastric cancer (P < 0.05).Conclusion The use of antiplatelet drugs, anticoagulants, and multiple antithrombotic drugs is independent risk factors for delayed bleeding after ESD for early gastric cancer, with risk increasing with the number of drug types. Submucosal invasion also significantly increases the risk of delayed bleeding.