内镜下冷圈套器切除直径<1cm的结直肠息肉疗效及迟发出血风险分析

Analysis of the Efficacy and Risk of Delayed Bleeding in the Resection of Colorectal Polyps<1cm in Diameter with an Endoscopic Cold Snare

目的:探讨内镜下冷圈套器切除直径<1cm的结直肠息肉的疗效及迟发出血风险因素。方法:回顾性分析2018年9月至2020年2月医院收治的410例行内镜下切除术的直径<1cm的结直肠息肉患者的资料,按照切除方式不同分为冷圈套器切除术组(n=214例)和热圈套器切除术组(n=196例)。比较两组患者息肉切除时间、完整息肉切除率、息肉回收率、并发症发生情况,并统计迟发性出血发生情况,比较出血患者和未出血患者临床特征,采用Logistic回归分析判定影响内镜下切除直径<1cm的结直肠息肉患者迟发性出血的因素。结果:两组患者基本资料比较,差异无统计学意义(P>0.05);冷圈套器切除术组患者息肉切除时间短于热圈套器切除术组(P<0.05),冷圈套器切除术组患者迟发性出血发生率低于热圈套器切除术组(P<0.05),两组完整息肉切除率、息肉回收率、腹部不适发生率、穿孔发生率比较,差异均无统计学意义(P>0.05);出血患者性别、糖尿病、冠心病、高血压、脑血管疾病、息肉数量、使用钛夹、息肉病理类型、抗凝药服用史构成比以及年龄、息肉直径与未出血患者比较,差异均无统计学意义(P>0.05),出血患者息肉位置、术中出血、息肉形态、切除方式构成比与未出血患者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析显示息肉位置、息肉形态、切除方式均是影响内镜下切除直径<1cm的结直肠息肉患者迟发性出血的独立危险因素(P<0.05)。结论:内镜下冷圈套器切术用于除直径<1cm的结直肠息肉患者能够缩短息肉切除时间,降低迟发性出血发生率,且息肉位置、息肉形态、切除方式均是影响内镜下切除直径<1cm的结直肠息肉患者迟发性出血的独立危险因素。

Objective:To explore the efficacy of endoscopic cold snare resection of colorectal polyps with a diameter<1 cm and the risk factors for delayed bleeding.Methods:The data of 410 patients with colorectal polyps with a diameter<1cm who underwent endoscopic resection from September 2018 to February 2020 were retrospectively analyzed,and according to the different resection methods,they were divided into cold snare resection group(n=214 cases)and hot snare resection group(n=196 cases).The polyp resection time,complete polyp resection rate,polyp recovery rate were compared,complication occurrence of the two groups of patients and the occurrence of delayed bleeding were counted,and the clinical characteristics of bleeding patients and non-bleeding patients were compared.Logistic regression analysis was used to determine the factors affecting delayed bleeding in patients with colorectal polyps with a diameter<1 cm under endoscopic resection.Results:There were no statistically significant difference in the basic data of the two groups of patients(P>0.05).The time of polyp removal in the cold snare resection group was shorter than that in the hot snare resection group(P<0.05),and the incidence of delayed bleeding in the cold snare resection group was lower than that in the hot snare resection group(P<0.05),there were no statistically significant difference in the resection rate of intact polyps,the recovery rate of polyps,the incidence of abdominal discomfort,and the incidence of perforation between the two groups(P>0.05).Compared with patients without bleeding,there were no statistically significant difference in gender,diabetes,coronary heart disease,hypertension,cerebrovascular disease,polyp number,use of titanium clamps,polyp pathological type,anticoagulant medication history,age,and polyp diameter(P>0.05),the polyp position,intraoperative bleeding,polyp morphology,and composition ratio of the resection method in bleeding patients were compared with those in non-bleeding patients,and the differences were statistically significant(P<0.05).Logistic multivariate regression analysis showed that polyp location,polyp morphology,and resection method are independent risk factors for delayed bleeding in patients with colorectal polyps with a diameter<1cm under endoscopic resection(P<0.05).Conclusion:Endoscopic cold snare resection for patients with colorectal polyps with diameter<1cm can shorten the time of polyp resection and reduce the incidence of delayed bleeding.In addition,the location of polyps,polyp morphology,and resection methods are independent risk factors that affect delayed bleeding in patients with colorectal polyps with a diameter diameter<1 cm under endoscopic resection.