急诊肠镜治疗大肠息肉切除术后迟发性出血的疗效评价

Efficacy evaluation of emergency colonoscopyin the treatment of delayed bleedingafter polypectomy of colorectal polyps

目的 观察急诊肠镜下止血对大肠息肉内镜黏膜切除术(endoscopic mucosal resection,EMR)术后发生迟发性出血患者的临床疗效。方法 回顾性分析2018年3月至2022月3月在杭州师范大学附属医院行大肠息肉EMR术后发生迟发性出血且经药物保守治疗仍有活动性出血而行急诊肠镜下止血的15例患者的临床资料,分析治疗后患者的即刻止血率、有效止血率、彻底止血率和再出血率,评价急诊肠镜对迟发性出血的治疗效果。结果 15例患者共发现18处息肉切除术后创面或裸露血管出血。出血部位无特异性;18处出血的息肉中,11处为直径≥10mm的息肉,占61.1%;息肉类型大部分为腺瘤性息肉,共16处,占88.9%;出血多发生在术后1~4d,中位天数1d。所有患者均在出血病灶处或钛夹边缘增加钛夹进行加固止血,即刻止血率100%。其中14例患者术后1~7d均未观察到再出血表现,有效止血率93.3%,1例患者治疗后2d再次发生活动性出血,再出血率为6.7%。再次行急诊肠镜下钛夹止血,术后观察1~7d无再出血。所有患者术后随访至30d,均未发生再次出血及并发症,彻底止血率为100%。结论 对于大肠息肉切除术后发生迟发性出血的患者,若经保守治疗效果欠佳,建议尽早行急诊肠镜下止血,术中使用金属钛夹或增加钛夹个数进行止血可达到满意止血效果。

Objective To observe the clinical efficacy of emergency endoscopic mucosal resection(EMR) hemostasis in patients with delayed bleeding. Methods Retrospective analyzed the clinical data of 15 patients with delayed bleeding after EMR in Affiliated Hospital of Hangzhou Normal University from March 2013 to March 2022, who still had active bleeding after conservative treatment with drugs, thus performed emergency colonoscopy for hemostasis.The immediate hemostasis rate, effective hemostasis rate, complete hemostasis rate and rebleeding rate of patients after treatment were analyzed, and the therapeutic effect of emergency enter oscopy on delayed hemorrhage was evaluated. Results Among 15 patients, 18 wounds or exposed blood vessels were found after poly pectomy of colorectal polyps. There is no specific site of bleeding. Among the 18 bleeding polyps, 11 polyps were ≥10mm in diameter.Most polyps were adenomatous polyps with 16 cases(88.9%). Most of the delayed bleeding occurred from 1 to 4 days after polypectomy of colorectal polyps, with a median of one day. During emergency colonoscopy, titanium clips were added to the bleeding focus or the edge of the titanium clip for reinforcement and hemostasis, and the immediate hemostasis rate was 100%. No rebleeding was observed in 14 patients 1 to 7 days after operation, and the effective hemostasis rate was 93.3%.One patient was occurred active bleeding again, 2 days after the first colonoscopic hemostasis, and the rebleeding rate was 6.7%. Emergency colonoscopy was performed again, and no further bleeding was observed 1 to 7 days after operation. All patients were followed up for 30 days after colonoscopic hemostasis, and no rebleeding or complications occurred, and the complete hemostasis rate was 100%. Conclusion For patients with delayed bleedingafter polypectomy, if the effect of conservative treatment is not good, it is recommended to perform emergency colonoscopy for hemostasis as soon as possible. Using titanium clips or increasing the number of titanium clips at the edge of the lesion can achieve satisfactory results for hemostasis.