结肠病变肠镜治疗后延迟性出血45例临床分析

Clinical analysis of delayed hemorrhage after colonoscopic treatment in 45 patients with colonic disease

目的分析结直肠病变肠镜治疗后延迟性出血的原因及再次肠镜治疗价值。方法回顾第三军医大学大坪医院2010年1月至2016年12月收治的结直肠隆起性病变(息肉、腺瘤、早癌、脂肪瘤)肠镜下给予氩气刀凝固术、黏膜下切除术、黏膜下剥离术或尼龙绳套扎术治疗后延迟出血的45例患者,针对其延迟性出血的病因,总结再次肠镜治疗的方式及临床结局。结果肠镜治疗后延迟性出血的好发部位依次是直肠(28.89%),乙状结肠(24.44%),升结肠(22.22%);腺瘤及上皮内瘤变病灶更易发生(88.89%)。延迟性出血的形式主要为病灶切除处创面渗血,也可有血管涌血或喷血。本组延迟性出血肠镜下治疗方式主要是钛夹夹闭和圈夹缝合,5例黏膜下注射1∶10 000肾上腺素及氩气刀凝固术治疗,35例氩气刀凝固术合并钛夹夹闭术治疗,3例钛夹夹闭治疗,2例圈夹止血治疗。42例一次性肠镜止血成功,3例又出血,再次行肠镜下治疗,1例重新给予钛夹夹闭及圈夹止血后出血停止,另2例转外科行结肠切除术。本组43例延迟性出血患者均经肠镜下止血成功,痊愈出院。肠镜治疗后牢固的创面处理对预防延迟性出血十分重要,患者的基础疾病及术后饮食管理也是延迟性出血的重要因素。结论对于肠镜治疗后延迟性出血患者及时再次进行肠镜检查及有效治疗,可取得满意的临床效果。

Objective To analyze the causes of delayed hemorrhage after colonoscopic treatment in colorectal diseases and the value of second colonoscopic treatment. Methods A retrospective study was conducted on 45 patients with colorectal protrusion le- sions （polyps,adenoma,early carcinoma and lipoma） in the Daping hospital of the Third Military medical University from January 2010 to December 2016. The patients suffered from delayed hemorrhage after argon knife coagulation, submucosal resection,submu- cosal dissection or nylon snares colonoscopic treatment. The mode and clinical outcome of second colonoscopic treatment were sum- marized by aiming at the reasons of delayed hemorrhage. Results The predilection sites of delayed hemorrhage were in turn rectum （28.89 ~//0 ）, sigmoid colon （24.44 ~） and ascending colon （22.22 %）. Adenoma and intraepithelial neoplasia lesions were easier to occurr （88.89 ~）. The types of delayed hemorrhage were mainly blood oozing at the lesion resection wound surface as well as blood gushing or ejection. The second colonoscopic treatment modes in these cases were mainly titanium clipping and ring clipping and su- turing. Five cases were treated by submucosal injection of adrenaline （1 .＂ 10 000） combined with argon knife coagulation. Thirty-- five cases conducted argon knife coagulationcombined with titanium clipping, 3 cases conducted titanium clipping and 2 cases adopt- ed ring clipping hemostasis. Forty-two cases stopped bleeding by once colonoscopic treatment,while 3 cases suffered from re-bleed- ing,the colonoscopic treatment was performed again, 1 case stopped bleeding after using titanium clipping and ring clipping hemo- stasis again, while other 2 cases were transfered to the surgery department for conducting colectomy. All 43 cases of delayed hemor- rhage in this group were cured and discharged after successful hemostasis by colonoscopy. The firm wound treatment after colono- scopic treatment was very important for preventing delayed hemorrhage,and the underlying diseases and postoperative diet manage- ment were also the important factors of delayed hemorrhage. Conclusion Timely second colonoscopic examination and treatment can obtain satisfactory clinical effects in the patients sufferring from delayed hemorrhage after colonoscopic treatment.