早期结直肠癌及癌前病变术后患者迟发性出血发生的危险因素分析

Analysis of the risk factors for a delayed bleeding in patients with early colorectal cancer and precancerous lesions after surgery

目的 分析早期结直肠癌及癌前病变术后患者迟发性出血发生的危险因素。方法 回顾性收集370例早期结直肠癌及癌前病变患者的临床资料,根据经内镜下手术治疗后是否发生迟发性出血分为出血组(27例)和未出血组(343例)。统计2组临床一般资料进行单因素分析,并通过多因素Logistic回归分析早期结直肠癌及癌前病变患者经内镜下手术治疗后发生迟发性出血的危险因素。结果 370例早期结直肠癌及癌前病变患者经内镜下手术治疗后发生迟发性出血发生率为7.30%(27/370)。单因素结果分析显示,出血组多发病灶、病灶≥3 cm、病灶位于直肠、病灶黏膜下层重度纤维化、使用抗血小板和/或抗凝药物史患者占比(59.26%、51.85%、70.37%、70.37%、62.96%)高于未出血组(26.24%、31.78%、45.19%、36.73%、42.57%)(P<0.05)。多因素Logistic回归分析结果显示,多发病灶、病灶≥3 cm、病灶位于直肠、病灶黏膜下层重度纤维化、使用抗血小板和/或抗凝药物史均为早期结直肠癌及癌前病变患者经内镜下手术治疗后发生迟发性出血的独立危险因素(OR=2.190、1.960、2.442、2.166、2.683,P<0.05)。结论 早期结直肠癌及癌前病变患者经内镜下手术治疗后发生迟发性出血的独立危险因素包括多发病灶、病灶≥3 cm、病灶位于直肠、病灶黏膜下层重度纤维化、使用抗血小板和/或抗凝药物史,临床可对有以上特征的患者进行针对性治疗或干预,以降低患者经内镜下手术治疗后发生迟发性出血风险。

Objective To analyze the risk factors for a delayed bleeding in patients with early colorectal cancer and precancerous lesions after surgery.Methods The clinical data of the 370 patients with early-stage colorectal cancer and precancerous lesions were collected retrospectively,and they were divided into a bleeding group(27 cases)and a non-bleeding group(343 cases)according to whether a delayed bleeding occurred after an endoscopic surgery.The general clinical data of the two groups were analyzed by a univariate analysis,and the factors with statistical significance in the univariate analysis were analyzed by a multivariate Logistic regression.Results In the 370 patients with early colorectal cancer and precancerous lesions,the incidence of a delayed bleeding after an endoscopic surgery was 7.30%(27/370).The univariate analysis showed that the proportion of patients with multiple lesions,lesions ≥3 cm,lesions located in rectum,severe fibrosis of lesions submucosa and a history of using antiplatelet and/or anticoagulant drugs in the bleeding group(59.26%,51.85%,70.37%,70.37%,62.96%)was higher than that in the non-bleeding group(26.24%,31.78%,45.19%,36.73%,42.57%)(P<0.05).The multivariate Logistic regression analysis showed that multiple lesions,lesions≥3 cm,lesions located in rectum,severe fibrosis of lesions submucosa,and a history of using antiplatelet and/or anticoagulant drugs were independent risk factors for a delayed bleeding in patients with early colorectal cancer and precancerous lesions after an endoscopic surgery(OR=2.190,1.960,2.442,2.166,2.683,P<0.05).Conclusion The independent risk factors for a delayed bleeding in patients with early colorectal cancer and precancerous lesions after an endoscopic surgery include multiple lesions,lesions ≥3 cm,lesions located in rectum,severe fibrosis of lesions submucosa,and a history of using antiplatelet and/or anticoagulant drugs.Therefore,a targeted treatment or intervention can be given to patients with the above characteristics in order to reduce the risk of a delayed bleeding after an endoscopic surgery.