内镜下结直肠息肉切除术后迟发性出血的危险因素分析

摘要

Objective This paper attempts to investigate the risk factors for delayed polypectomy bleeding(DPPB)after endoscopic colorectal polypectomy in order to reduce the risk of DPPB.Methods 426 patients were selected to undergo endoscopic treatment for colorectal polyps from January 2010 to December 2017,of which,262 cases were treated with snare removal,128 cases with endoscopic mucosal resection(EMR),and 36 cases with endoscopic submucosal dissection(ESD).The clinical data,blood biochemical indicators,endoscopy,and pathological examination data of the patients were collected.According to whether or not DPPB occurred after endoscopic treatment,the patients were divided into the DPPB group and the non-bleeding group.Statistical analysis was performed on the general data and related factors of the two groups to analyze the independent risk factors for DPPB. Resuits In 426 cases,21 cases of DPPB occurred(4.93%).The proportion of hypertension and diabetes in the DPPB group was higher than that in the non-bleeding group(P<0.05).The incidence of DPPB in patients treated with ESD was 1 1.1 1 %,which was higher than that of snare removal(2.29%) and EMR(8.59%)(P<0.01).The incidence of DPPB in patients with polyps in the rectum,left colon, transverse colon and right colon was 9.26%,3.51% and 3.4%,respectively.The incidence of DPPB in patients with rectal polyps was higher than that in other sites(P<0.05).The incidence of DPPB in patients with a polyp>0.9 cm(7.6%)was higher than that in patients with a polyp≤0.9 cm(1.14%) (P<0.01).The incidence of DPPB in patients with pedunculated polyps(6.73%)was not statistically different from that of sessile polyps(2.96%)(P>0.05).The incidence of DPPB in adenomatous polyps (7.04%)was higher than that in hyperplastic polyps(2.08%)(P<0.05).The incidence of DPPB in patients with intraoperative hemorrhage(9.52%)was not significantly different from that in patients without intraoperative hemorrhage(4.43%)(P>0.05).Conciusions Hypertension,diabetes,rectal polyps,polyps >0.9 cm,adenomatous polyps,and ESD therapy are risk factors for endoscopic DPPB in colorectal polypectomy.The above-mentioned risk factors should be fully considered and paid attention to during operation,which will help to reduce the risk of DPPB.%目的 探讨内镜下结直肠息肉切除术后迟发性出血(DPPB)的危险因素,以期降低DPPB的风险.方法 选取2010年1月至2017年12月因结直肠息肉接受内镜下治疗的426例患者,其中行圈套摘除治疗262例、内镜下黏膜切除术(EMR)128例、内镜黏膜下剥离术(ESD)36例.收集研究对象的临床资料、血液生物化学指标、内镜和病理检查资料.根据内镜下治疗后是否发生DPPB,将患者分为DPPB组和未出血组.对两组的一般资料及相关因素进行统计学分析,分析DPPB的独立危险因素.结果426例患者中有21例发生DPPB(4.93%).DPPB组中高血压和糖尿病患者的比例较未出血组更高(P<0.05).接受ESD治疗的患者DPPB发生率为11.11 %,高于接受圈套摘除(2.29%)和EMR(8.59%)的患者(P<0.01).息肉位于直肠、左半结肠、横结肠+右半结肠的患者DPPB发生率分别为9.26%、3.51 %和3.4%,直肠息肉患者的DPPB发生率高于其他部位息肉患者(P<0.05).息肉直径>0.9 cm的患者的DPPB发生率(7.6%)高于息肉直径≤0.9 cm的患者(1.14%)(P<0.01).有蒂息肉患者的DPPB发生率(6.73%)与无蒂息肉患者(2.96%)相比差异无统计学意义(P>0.05).腺瘤性息肉患者的DPPB发生率(7.04%)高于增生性息肉患者(2.08%)(P<0.05).有术中出血患者的DPPB发生率(9.52%)与无术中出血患者(4.43%)相比差异无统计学意义(P>0.05).结论 高血压、糖尿病、直肠息肉、息肉直径>0.9 cm、腺瘤性息肉及ESD治疗是内镜下结直肠息肉切除术发生DPPB的危险因素.操作时应充分考虑上述危险因素并加以重视,有利于降低DPPB的风险.