儿童肠息肉术后电凝综合征的临床特征及危险因素分析

Clinical characteristics and risk factors of post polypectomy electrocoagulation syndrome in children

目的:探讨儿童肠息肉经结肠镜电切除术后电凝综合征(PPECS)的临床特征及相关危险因素,为儿科内镜医师提供防治依据。方法:回顾性分析郑州大学附属儿童医院内镜中心2015年1月至2019年12月收治的23例行内镜下肠息肉电切术后发生PPECS患儿的临床资料。并采用简单随机数字法选取同期由同一位内镜医师完成的手术115例作为非PPECS组。总结PPECS的发病率、临床特征及处理方案,发生PPECS的高危因素采用Logistic回归分析。结果:23例患儿术后出现PPECS,发病率为1.1%(23/2083),患儿术后均出现腹痛、发热;年龄(3.5±1.5)岁,年龄≤3岁19例(82.6%);肠息肉直径≥25 mm的18例(78.3%)。PPECS组的内镜操作时间[(56±15)比(24±8)min,t=18.086,P<0.01]、分块切除比例[78.3%(18/23)比17.4%(20/115),χ^(2)=17.358,P<0.01]、病变直径大小[(38.4±3.7))比(15.8±4.3)mm,t=15.127,P<0.01]、息肉分布右半结肠[47.8%(11/23)比23.5%(27/115),χ^(2)=7.035,P<0.05]、广基息肉比例[78.3%(18/23)比25.2%(29/115),χ^(2)=29.259,P<0.01]均明显高于非PPECS组;PPECS组白细胞计数[(17.4±4.5)×10^(9)/L比(8.5±1.2)×10^(9)/L,t=6.085,P<0.05]、C反应蛋白[(25.8±3.6)比(1.1±0.6)mg/L,t=5.531,P<0.05]明显高于非PPECS组。多因素Logistic回归分析显示,病变直径≥25 mm(OR=7.554,95%CI 3.135~20.158,P=0.001)、广基息肉类型(OR=5.676,95%CI 1.153~9.596,P=0.002)及病变位置位于右半结肠(OR=5.845,95%CI 1.737~9.297,P=0.008)均是影响PPECS发生的独立危险因素。结论:PPECS以息肉术后发热、腹痛及白细胞升高为特征。病变直径大小≥25 mm、广基息肉类型及病变位置位于右半结肠是PPECS发生的独立危险因素。

Objective To study the clinical characteristics and risk factors of post polypectomy electrocoagulation syndrome(PPECS)in children.Methods Clinical data of 23 children with PPECS in Children′s Hospital Affiliated to Zhengzhou University from January 2015 to December 2019 were retrospectively analyzed.Additionally,115 children without PPECS who had polypectomy performed by the same endoscopist at the same time were collected into the control group.The morbidity,clinical characteristics and therapeutic protocol were analyzed,and the risk factors of PPECS were analyzed by Logistic regression.Results Among the total 2083 children who had endoscopic polypectomy with electrocautery,23 children(1.1%)developed PPECS.All had abdominal pain and fever.The average age of the children with PPECS was(3.5±1.5)years,including 19 cases(82.6%)younger than 3 years.There were 18 cases with polyps larger than 25 mm(78.3%).The endoscopic operation time((56±15)vs.(24±8)min,t=18.086,P<0.01),the rate of piecemeal resection(78.3%(18/23)vs.17.4%(20/115),χ^(2)=17.358,P<0.01),the lesion size((38.4±3.7)vs.(15.8±4.3)mm,t=15.127,P<0.01),the proportion of polyps located in the right hemicolon(47.8%(11/23)vs.23.5%(27/115),χ^(2)=7.035,P<0.05),and the proportion of broad-based polyps(78.3%(18/23)vs.25.2%(29/115),χ^(2)=29.259,P<0.01)in the PPECS group were all significantly higher than those in the non-PPECS group.Similarly,the leukocyte counts((17.4±4.5)×109/L vs.(8.5±1.2)×10^(9)/L,t=6.085,P<0.05)and C-reactive protein((25.8±3.6)vs.(1.1±0.6)mg/L,t=5.531,P<0.05)in the PPECS group were higher than those in the non-PPECS group.The results of multivariate Logistic regression analysis indicated that lesion size≥25 mm(OR=7.554,95%CI 3.135-20.158,P=0.001),broad-based polyps(OR=5.676,95%CI 1.153-9.596,P=0.002)and lesion located in the right hemicolon(OR=5.845,95%CI 1.737-9.297,P=0.008)were independent risk factors of PPECS.Conclusions The clinical features of PPECS in children are fever,abdominal pain and leukocytosis after the procedure.The lesion size≥25 mm,broad-based polyps and lesion located in the right hemicolon are the independent risk factors of pediatric PPECS.