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目的:探讨影响内镜下黏膜切除术(EMR)或内镜黏膜下剥离术(ESD)后体温升高的影响因素,为EMR或ESD围手术期合理应用抗菌药物提供依据.方法:采用回顾性研究方法,收集109例我院消化内镜中心行EMR或ESD术治疗患者的临床资料,按体温分为A组(T＜37℃)和B组(T≥37℃).对比A、B两组患者年龄、性别、肿瘤大小、内镜类型、病灶部位,是否预防应用抗菌药物,比较术前术后炎症指标变化.结果:A组与B组肿瘤大小和内镜类型比较,差异有统计学意义(P＜0.05);而两组年龄、性别、病灶部位比较,差异无统计学意义(P＞0.05).行ESD术患者均预防应用抗菌药物;A、B两组行EMR术患者预防应用抗菌药物比例无明显差异(P＞0.05).无论是否应用抗菌药物,A组、B组以及全部患者术后白细胞计数均较术前显著升高(P＜0.05),而中性粒细胞比例无显著变化(P＞0.05).结论:ESD术及病灶较大患者内镜后更易发热.EMR术后预防性应用抗菌药物并未降低术后发热率,因此EMR术无需常规预防性应用抗菌药物.","Objective:To examine the factors associated with fever in patients who underwent endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for gastrointestinal lesions,and to provide valuable reference for rational use of antibiotics.Methods:A total of 109 patients who underwent ESD or EMR at endoscopy center were reviewed with retrospective study.The patients were devided into two groups based on the body temperature on the day after EMR/ESD:group A,body temperature ＜ 37℃;and group B,body temperature ≥37℃.The clinical data of the two groups were compared,including age,gender,tumor size,surgical mode,location,with or without prophylaxis with antibiotics,and inflammatory markers before and after the surgery.Results:There were significant differences between the two groups in tumor size and surgical mode (P ＜ 0.05).However there was no significant difference between the two groups in age,gender and location (P ＞ 0.05).The investigation revealed that patients who underwent ESD were prophylactically applied with antibiotics;The proportion of patients who underwent EMR given prophylactically antibiotics in group A and B had no significant difference (P ＞ 0.05).Whether or not antibiotics were used,The white blood cell counts in group A and B and all patients were dramatically increased than before surgary (P ＜ 0.05).While for the neutrophile granulocyte,there was no significantly change (P ＞ 0.05).Conclusion:This study indicated that post-ESD and patients with large tumors were more likely to develop fever,and we concluded that use of routine prophylactic antibiotics to patients undergoing esophageal EMR was unnecessary because post EMR transient fever couldn't be improved with empirical antibiotics in most cases.