结直肠息肉内镜下黏膜切除术后迟发性出血危险因素分析

Analysis of risk factors for delayed bleeding after endoscopic mucosal resection of colorectal polyps

目的 采用logistic回归分析结直肠息肉内镜下黏膜切除(EMR)术后迟发性出血的危险因素,评估血小板计数对EMR术后迟发性出血的预测价值,为评估EMR术后出血风险提供指导。方法 回顾性分析2018年9月至2021年6月于铜陵市人民医院消化内科住院行肠息肉内镜下黏膜切除术的348例病人的病例资料,按照术后是否发生迟发性出血分为出血组(n=29)和未出血组(n=319)。对两组病人的一般资料、血小板计数、凝血功能、合并疾病、息肉情况、EMR操作情况等进行比较;采用多因素logistic回归模型分析EMR术后迟发性出血的危险因素。结果 出血组病人血小板计数(84.8±24.1)×10^(9)/L低于未出血组病人(141.0±49.9)×10^(9)/L(P<0.05)。凝血功能、合并高血压病、糖尿病、心血管疾病、慢性肝、肾疾病的比例与未出血组比较差异无统计学意义(P>0.05)。出血组中息肉分布于多个肠段的病人比例55.2%(16/29)和发生术中出血的病人比例48.3%(14/29)均高于未出血组的34.8%(111/319)及9.4%(30/319)(P<0.05)。单次息肉切除数量(2.8±1.3)枚和息肉基底最大径(1.1±0.2)mm明显高于未出血组的(1.8±0.8)枚及(0.7±0.2)mm(P<0.05)。logistic回归分析显示血小板计数、单次切除息肉数量和息肉基底最大径是EMR治疗后迟发出血的独立危险因素。结论 血小板计数低、单次切除息肉数目多、切除息肉底径大是EMR治疗后发生迟发性出血的危险因素。

Objective Logistic regression was used to analyze the risk factors for delayed bleeding after endoscopic mucosal resection(EMR) of colorectal polyps and to assess the predictive value of platelet count for delayed bleeding after EMR to provide guidance for assessing the risk of bleeding after EMR.Methods A retrospective analysis of 348 patients who were hospitalized in the Department of Gastroenterology,Tongling People’s Hospital for EMR of colorectal polyps from September 2018 to June 2021 were retrospectively analyzed and divided into a bleeding group(n=29) and a nonbleeding group(n=319) according to whether delayed bleeding occurred after surgery.The general information,platelet count,coagulation function,comorbidities,polyp condition and EMR operation were compared between the two groups;a multivariate logistic regression model was used to analyze the risk factors for delayed bleeding after EMR.Results The platelet count of patients in the bleeding group [(84.3±24.1)×10^(9)/L] was lower than that in the nonbleeding group [(141.0±49.9)×10^(9)/L](P<0.05).There was no significant difference in the proportion of coagulation function,combined hypertension,diabetes,cardiovascular disease,chronic liver and kidney disease compared with the nonbleeding group(P>0.05).The proportion of patients with polyps distributed in multiple bowel segments was 55.2%(16/29),and the proportion of patients with intraoperative bleeding was 48.3%(14/29) in the bleeding group,which was higher than those in the nonbleeding group [34.8%(111/319) and 9.4%(30/319)](P<0.05).The number of polyps resected(2.8±1.3) and the maximum diameter of polyp base(1.1±0.2) mm in the single EMR group were significantly higher than those in the nonbleeding group [(1.8±0.8) and(0.7±0.2)mm](P<0.05).Logistic regression analysis showed that platelet count,the number of polyps resected in a single EMR,and the maximum diameter of the polyp base were independent risk factors for delayed bleeding after EMR treatment.Conclusion Low platelet count,large number of polyps removed during single EMR and large diameter of polyps resected are risk factors for delayed bleeding after EMR treatment.