内镜下结肠息肉切除术后并发出血的危险因素分析

Risk factors analysis of bleeding after endoscopic polypectomy of colon

目的探讨内镜下结肠息肉切除术后并发出血的危险因素。方法选取2017年1月~2019年6月于九江市柴桑区人民医院行内镜下结肠息肉切除术的126例患者作为研究对象,依据是否并发出血分为病例组(并发出血组)8例和对照组(没有并发出血组)118例。比较两组患者的临床资料,分析术后出血的危险因素。结果126例患者中并发出血的有8例,发生率为6.35%。单因素分析结果显示,两组患者的糖尿病、高脂血症、家族史、吸烟史、体重指数(BMI)、术后进食时间、息肉大小、息肉形态、息肉数量比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,糖尿病(β=2.407,OR=1.846,95%CI 1.135~2.473)、高脂血症(β=2.561,OR=2.843,95%CI 1.153~3.746)、术后进食时间<24 h(β=3.427,OR=2.486,95%CI 1.736~3.418)、息肉形态为无蒂息肉(β=1.168,OR=1.572,95%CI 0.745~1.948)是内镜下结肠息肉切除术后并发出血的独立危险因素(P<0.05)。结论患者伴有糖尿病、高脂血症、术后进食时间<24 h、息肉形态为无蒂息肉时,内镜下结肠息肉切除术后并发出血的风险增加。操作时应充分考虑上述危险因素并加以重视,提前采取有效措施,有利于降低出血的风险。

Objective To explore the risk factors of bleeding after endoscopic polypectomy of colon.Methods A total of 126 patients with colon polyps underwent endoscopic polypectomy in Chaisang District People′s Hospital of Jiujiang City from January 2017 to June 2019 were selected as the subjects.According to whether hemorrhage occurs,the patients were divided into case group(hemorrhage group)8 cases and control group(no hemorrhage group)118 cases.The clinical data of two groups were compared,and the risk factors of postoperative bleeding were analyzed.Results Of 126 patients,8 cases had hemorrhage,and the complication rate was 6.35%.Univariate analysis showed that there were significant differences in diabetes mellitus,hyperlipidemia,family history,smoking history,body mass index(BMI),postoperative eating time,polyp size,polyp morphology and polyp number between the two groups(P<0.05).Multivariate Logistic regression analysis showed that diabetes(β=2.407,OR=1.846,95%CI 1.135-2.473),hyperlipidemia(β=2.561,OR=2.843,95%CI 1.153-3.746),postoperative feeding time<24 h(β=3.427,OR=2.486,95%CI 1.736-3.418),polyps with no pedicled polyps(β=1.168,OR=1.572,95%CI 0.745-1.948)were independent risk factors for bleeding after polypectomy(P<0.05).Conclusion Patients with diabetes mellitus,hyperlipidemia,food intake less than 24 hours after operation,polyp form as pediceless polyp,and the risk of bleeding after colon polyp resection under endoscope increased.The risk factors mentioned above should be fully considered and taken into account during operation,and effective measures should be taken in advance to reduce the risk of bleeding.