结肠息肉内镜摘除术后并发症发生特征及危险因素分析

Analysis of the risk factors and characteristics of postoperative complications of endoscopic polypectomy for intestinal polyps

目的分析结肠息肉内镜摘除术后并发症发生特征以及危险因素。方法选取贵州省人民医院2015年4月至2017年4月期间收治的378例拟行内镜摘除术治疗的结肠息肉患者,收集患者临床资料进行回顾性分析。根据并发症发生情况将患者分成并发症组与无并发症组,分析患者的临床资料,探讨影响结肠息肉内镜摘除术后并发症发生的危险因素以及并发症的发生特征。结果 (1)并发症的类型主要有腹痛、出血、感染等,发生并发症24例,占6.35%;(2)并发症组与无并发症组患者在合并高血压、合并高血脂、息肉大小、息肉形态、息肉数量存在明显差异(P<0.05);(3)热活检钳咬除术、圈套器勒除术、APC、注射后高频电切除术、ESD/EMR、混合手术并发症发生率分别为1(3.23%)、6(16.67%)、1(1.64%)、1(0.63%)、2(6.67%)、13(36.11%),混合手术与圈套器勒除术并发症发生明显高于热活检钳咬除术、APC、注射后高频电切除术、ESD/EMR(P<0.05);(4)合并高血压、合并高血脂、息肉直径≥2.0 cm、息肉数量≥2个、有蒂息肉、混合手术是影响内镜摘除术后并发症发生的危险因素(P<0.05)。结论结肠息肉内镜摘除术后并发症以出血、腹痛与感染为主;而合并高血压、合并高血脂、息肉直径≥2.0 cm、息肉数量≥2个、有蒂息肉及手术方式与结肠息肉内镜摘除术后并发症发生有关,合适的手术方式可降低结肠息肉患者术后并发症的发生。

Objective To analyze the risk factors and characteristics of postoperative complications of endoscopic polypectomy for intestinal polyps. Methods The clinical data of 378 patients with intestinal polyps who underwent endoscopic polypectomy in Guizhou People ＇s Hospital from April 2015 to April 2017 were retrospectively analyzed. The patients were divided into complication group and non-complication group according to the occurrence of complications. Then the risk factors and characteristics of postoperative complications were analyzed based on the data. Results（ 1） The main complications including abdominal pain,bleeding,infection and so on were found in 24 cases,accounting for 6. 35%.（ 2） Significant differences were found between complication group and non-complication group in terms of combined hypertension,combined hyperlipidemia,polyp size,polyp morphology and polyp number（ P〈0. 05）.（ 3） The incidences of complications from low to high were high frequency electroexcision（ 1 cases,0. 63%）,APC（ 1 cases,1. 64%）,hot biopsy forceps（ 1 cases,3. 23%）,ESD/EMR（ 2 cases,6. 67%）,snare excision（ 6 cases,16. 67%）,and mixed operation（ 13 cases,36. 11%）.The incidences of complications after mixed operation and snare excision were significantly higher than that after hot biopsy forceps,APC,high frequency electroexcision and ESD/EMR（ P〈0. 05）.（ 4） Hypertension,hyperlipidemia,polyp diameter ≥2. 0 cm,polyp number ≥2,pedunculated polyps,mixed operation were the risk factors for postoperative complications of endoscopic polypectomy for intestinal polyps（ P〈0. 05）. Conclusion The main postoperative complications are abdominal pain,bleeding and infection. While hypertension,hyperlipidemia,polyp diameter ≥2. 0 cm,polyp number ≥2,pedunculated polyps,operation mode are related to the postoperative complications. Selecting appropriate operation mode can effectively reduce the incidence of complications.