内镜下结肠息肉治疗术后出血危险因素分析及干预措施研究

Analysis of the risk factors of delayed bleeding after endoscopic resection of colorectal polyps and intervention study

目的分析内镜下结肠息肉治疗术后迟发性出血高危因素,为临床内镜下合理治疗提供理论依据。方法回顾性分析2013年1月到2017年1月在北京海军总医院消化内科行内镜下结肠息肉切除术的1 800例患者,分析迟发性出血的相关危险因素。结果术后迟发性出血38例(2. 1%),男21例,女17例,术后出血时间(2. 05±1. 27) d,1～3 d发生迟发性出血(32例)多于3～6 d(6例)。术后迟发性出血危险因素包括息肉大小(≥1. 5 cm)、息肉形态(有蒂)、高血压病史、动脉硬化病史、体质量指数(body mass index,BMI)(≥28 kg/m2)、息肉生长部位(直肠及乙状结肠)(OR=0. 115、9. 594、0. 008、36. 414、0. 001、0. 471,P均<0. 05)。结论本研究中内镜下结肠息肉切除术后迟发性出血的发生率为2. 1%,且多发生在术后1～3 d,其中息肉越大、带蒂息肉、位于乙状结肠及直肠的息肉术后迟发性出血的风险增加。息肉治疗术后创面采取热活检钳处理联合钛夹钳夹创面,迟发性出血发生率显著减少。此外,BMI较高的患者、合并高血压、动脉硬化等一般因素也提示存在较高的迟发性出血风险。

ObjectiveTo analyze the risk factors of delayed bleeding after endoscopic resection of colorectal polyps and to provide a theoretical basis for rational clinical endoscopic treatment.MethodsOne thousand and eight hundred patients who were underwent endoscopic polypectomy in the Department of Gastroenterology, Chinese PLA Navy General Hospital from Jan. 2013 to Jan. 2017 were analyzed retrospectively, the risk factors associated with delayed bleeding were analyzed.ResultsDelayed bleeding occurred in 38 patients （2.1%）, 21 males and 17 females, the time of bleeding were （2.05± 1.27 ） days. The number of delayed bleeding occurred in 1-3 days （32 cases） more than 3-6 days （6 cases）. The risk factors of postoperative delayed bleeding included polyp size （≥1.5 cm）, polyp morphology （pedicle）, history of hypertension, history of atherosclerosis, body mass index （BMI）（≥28 kg/m 2）, polyps growth site （rectum and sigmoid colon） （ OR =0.115, 9.594, 0.008, 36.414, 0.001, 0.471, all P 〈0.05）.ConclusionThe incidence of delayed bleeding after endoscopic polypectomy in this study was 2.1%, which occurred mostly 1-3 days after operation.As for polyposis treatment of postoperative wounds, taking hot biopsy forceps combined with titanium clamp jaw wound, delayed bleeding incidence was significantly reduced. In addition, patients with high BMI, as well as patients with hypertension and atherosclerosis also show a higher risk of delayed bleeding.