肠镜下息肉切除术后迟发性出血分析

Analysis of delayed bleeding after polypectomy with colonoscopy

目的分析肠镜下息肉切除术后迟发性出血患者资料,总结其危险因素及出血患者处理方法,为防治术后迟发性出血提供依据。方法回顾性分析2014年1月至2016年12月在第三军医大学大坪医院消化内科住院行肠镜下息肉切除术的1 243例患者资料,根据术后是否发生迟发性出血分为出血组与未出血组,比较2组患者的年龄、息肉大小、部位、术后病理并评估出血患者术后处理方法。结果 1 243例行肠镜下大肠息肉切除术患者中14例发生迟发性出血,发生率为1.13%。出血组有1例发生再次迟发性出血;有2例在迟发性出血止血后,因再次血便而行第3次肠镜检查。迟发性出血发生的时间为(4.73±2.49)d。出血组息肉好发部位为直肠(7/14,50%)。出血组息肉直径为(16.65±4.91)mm,大于未出血组的(8.07±4.23)mm,差异具有统计学意义(P<0.05)。出血组高血压、糖尿病患者比例高于未出血组,差异具有统计学意义(P<0.05)。出血组中幼年性息肉和管状腺瘤伴高级别上皮内瘤变多见(P<0.05)。出血组患者创面经荷包缝合、止血夹夹闭、电凝止血或注射止血后均达到止血效果。结论患者年龄大、伴高血压或糖尿病,息肉较大、位于直肠,幼年性息肉或管状腺瘤合并高级别上皮内瘤是迟发性出血的危险因素。在发生迟发性出血时,在肠镜下根据创面不同选择荷包缝合、止血夹夹闭、电凝、注射止血均能达到理想效果。

Objective Retrospectively analyzed the data of patients with delayed bleeding after colorectal polypectomy, summarized the risk factors and treatment methods of bleeding patients, and provided the basis for further prevention and treatment of postoperative delayed bleeding. Methods Collected the clinical data of 1 243 patients who were admitted into the department of gastroenterology of third affiliated hospital of the third military medical university and accepted polypectomy with colonoscopy from January 2014 to December 2016. Divided these patients into the bleeding group and the non-bleeding group according to whether there was delayed bleeding after surgery. The age, size of polypus, location of polypus, postoperative pathology of the two groups were compared and the postoperative treatment of bleeding was evalu- ated. Results Among the 1 243 patients underwent colorectal polypectomy, there were 14 cases of delayed bleeding, and the incidence was 1.13%. In the bleeding group,there was 1 case of secondary delayed bleeding and 2 cases of bloody stool after hemostasis for the delayed bleeding. Delayed bleeding occurred at （4.73 ± 2.49 ） days after surgery. The predilection site of of polypus was rectum in the bleeding group （7/14,50%）, and the diameter of polypus was （16.65 ± 4.91 ）mm in the bleeding group, which was lager than （8.07 ± 4.23 ）mm in the non-bleeding group with statistical difference （ P 〈 0.05 ）. The proportion of hypertensive and diabetic patients in the bleeding group was sig- nificantly higher than that in the non-bleeding group （ P 〈 0.05 ）. Juvenile polyps and tubular adenoma with high grade intraepithelial neopla- sia were more common in the bleeding group （ P 〈 0.05 ）. The bleeding group achieved good hemostatie effect by purse suture, hemostatic clip, eleetroeautery or injection hemostasis. Conclusion Older age, hypertension and diabetes,lager size of polypus, rectum polypus,juvenile polyps and tubular adenoma with high grade intraepithelial neoplasia were risk factor for delayed bleeding. In the event of delayed bleeding, different choice of purse suture, hemostatic clip, electrocautery or injection hemostasis according to different wounds can achieve the desired effect.