大肠息肉切除术后迟发性出血的危险因素分析

Risk factors of delayed postpolypectomy bleeding

目的结肠镜下息肉切除术能够有效预防大肠癌的发生,但术后出血为其最常见的并发症。由于迟发性出血较难处理,因此了解其发生的危险因素并采取预防措施是必要的。方法对2008年1月～2010年12月在南方医科大学珠江医院行内镜下大肠息肉切除术的2439例患者进行了调查分析,内容包括患者相关因素、息肉相关因素及治疗方式等,研究迟发性出血的危险因素。结果 2439例患者中23例发生了迟发性出血(0.94%),迟发性出血多发生在息肉切除后1～6d,平均(4.2±3.1d)d,平均年龄(55.4±11.7)岁,息肉平均直径(7.8±2.6)mm,男:女为18:5,高龄、高血压患者为迟发性出血的危险因素(P值分别为0.001及0.038);发生迟发性出血的息肉多分布于盲肠或升结肠(8例,1.7%)。其中21例迟发性出血直接通过止血夹止血,2例黏膜下注射肾上腺素后再应用止血夹止血。结论高龄、高血压患者及盲肠升结肠患者与息肉切除术后迟发性出血显著相关。对高危患者减少其危险因素、密切观察以及息肉切除后及时应用夹子预防性止血是必要的。

[Objective] The colonoscopic polypectomy has become a valuable procedure for removing precursors of colorectal cancer,but some complications can be occurred.The most common complication after colonoscopic polypectomy is bleeding.Because the management of delayed postpolypectomy bleeding could be difficult,the use of preventive technique and reductions of risk factors are essential.[Methods] From January 2008 to December 2010,delayed hemorrhage occurred in 23 of the 2439 polypectomy patients examined by one endoscopist.These cases were reviewed retrospectively for patient-related factors,polyp-related factors,and treatment methods.[Results] Delayed bleeding occurred in 23/2439 patients（0.94%）.Delayed bleeding was identified from 1 to 6 days after resection [mean,（4.2±3.1） days].The mean age was（55.4±11.7） years,and the average polyp size was（7.8±2.6） mm.The male-to-female ratio was 15：8.Higher age and hypertension were risk factors of delayed hemorrhage（P =0.001,0.038）.The most common site was the cecum and ascending colon（8 cases,1.7%）.Twenty-one cases were treated with clipping for hemostasis and tow cases with epinephrine injection.[Conclusions] Higher age,hypertension,cecum and ascending colon were associated with an increase in delayed postpolypectomy bleeding.Reducing risk factors and close observation were essential in high risk patients,and prompt management with hemoclips was effective.