结肠侧向发育型肿瘤内镜下治疗后延迟出血的原因和治疗对策

Treatment project and reasons of delayed bleeding in endoscopic treatment of laterally spreading colon tumor

目的探讨内镜下治疗结肠侧向发育型肿瘤后延迟出血发生的原因和治疗对策。方法分析了2001年9月至2011年9月来我院行内镜下治疗(包括内镜下黏膜切除术和内镜黏膜下剥离术)结肠侧向发育型肿瘤后延迟出血患者的临床资料,统计分析以下相关因素:(1)术前因素:如性别、年龄、伴发高血压、糖尿病及其他慢性病,既往服用抗凝药物,病变大小、部位等情况;(2)术中因素:病变切除情况,创面的处理方法,操作时间;(3)术后因素:患者饮食和活动量控制不理想。结果 1867例患者纳入研究,其中内镜下切除术后发生延迟出血34例。术后延迟出血的发生与病变长度、创面的处理方法以及术后患者饮食和活动的控制密切相关(P<0.05),而与患者的性别、部位、伴发病、既往是否服用抗凝药物、病变部位、病变切除情况、操作时间关系无显著性(P>0.05)。结论病变长度、创面的处理方法以及术后患者饮食和活动的控制是影响术后延迟出血发生率的重要因素,对于较大的结肠侧向发育型肿瘤应予以充分重视,应选择有效的创面处理方法并严格控制术后饮食和活动,预防延迟出血的发生。

Objective To evaluate the treatment projects and reasons of delayed bleeding in endoscopic treatment of laterally spreading colon tumor（LST）.Methods Clinical data of patients between September 2001 and September 2011 were collected in this study.The following factors associated with bleeding were analyzed：（1）preoperative factor：sex,age,concomitant diseases including hypertension and diabetes mellitus,history of administration of anticoagulants or anti-platelet agents,lesion size and location; （2） intraoperative factor：en-bloc resection,wound treatment and operation time; （3） postoperative factor：patient＇ s diet and activity control.Results 1867 patients were enrolled in this study,in which 34 patients were occurred with delayed bleeding.The occurrence of delayed bleeding was closely related to lesion size,wound treatment methods,and postoperative diet and activities of patients （P ＜ 0.05）,and there was little relation with sex,location,co-morbidity,previous taking anticoagulant drugs and operation time （P ＞ 0.05）.Conclusions Lesion size,wound treatment methods,and postoperative diet and activities of patients were important factors to affect the postoperative delayed bleeding.Adequate priority should be given to large size LST,and effective wound management should be chosen.Therefore,with strict control of postoperative diet and activities,we can reduce the incidence of delayed bleeding.