结肠息肉圈套器冷切除术后瞬时性出血风险因素分析

Risk factors for immediate bleeding after cold snare polypectomy

目的探讨结肠息肉圈套器冷切除术(CSP)后瞬时性出血的相关风险因素。方法收集2019年1月至2020年8月于安徽医科大学第一附属医院行结肠息肉CSP治疗的病人58例,依据是否发生瞬时性出血分为瞬时出血组7例,无出血组51例,比较两组性别、年龄、息肉大小、部位、形态、病理、血肿形成、圈套器冷切除创面突出物形成、创面大小及创面出血分级。结果共搜集58例病例包含137处病变,其中瞬时出血组病变14处,无出血组病变123处,单因素分析中,两组病变分布位置、形态、是否形成圈套器冷切除创面突出物、创面大小均差异无统计学意义(P>0.05),瞬时出血组与无出血组病变大小[(5.929±1.269)mm比(5.073±1.139)mm]、病理性质、是否形成血肿以及创面出血分级比较,差异有统计学意义(P<0.05)。多因素分析提示两组仅血肿形成及创面出血分级比较,差异有统计学意义(P<0.05)。结论结肠息肉冷切除术后创面血肿形成及明显渗血提示瞬时性出血风险较高,需适时追加内镜下止血治疗操作。

Objective To investigate the risk factors of immediate bleeding after cold snare polypectomy.Methods Data were collected on patients undergoing cold snare polypectomy and they were divided into the immediate bleeding group and non-bleeding group based on whether or not transient bleeding occurred.The age,gender,lesion size,site,morphology,pathology,hematoma formation,cold snare defect protrusion formation,wound size and wound bleeding grade were compared between the two groups.Results A total of 58 cases were collected,including 137 lesions,14 in the immediate bleeding group and 123 in the non-bleeding group.Through univariate analysis,there were significant differences in lesion size[(5.929±1.269)mm vs.(5.073±1.139)mm],pathology,hematoma formation,and wound bleeding grade between the two groups(P<0.05),but there were no significant differences in lesion site,morphology,cold snare defect protrusion formation,and wound size between the two groups(P>0.05).Multivariate analysis suggested that only hematoma formation and wound bleeding grade were significantly different between the two groups(P<0.05).Conclusions The formation of wound hematoma and oozing of blood after cold snare polypectomy suggest a higher risk of immediate bleeding.Additional endoscopic hemostatic procedures are required.