抗栓治疗老年患者行内镜下结肠息肉切除术的安全性分析

Safety analysis of endoscopic colonic polypectomy in elderly patients treated with antithrombotic therapy

目的研究抗栓治疗老年患者行内镜下结肠息肉切除术的安全性。方法回顾性分析内镜下结肠息肉切除的410例抗栓治疗老年患者的临床资料,根据患者术后是否发生出血、栓塞等不良事件分为正常组(335例,未发生出血及栓塞事件)、出血组(30例,发生出血事件)、栓塞组(45例,发生栓塞事件)。比较三组患者的基线资料、抗栓药物应用情况及息肉相关情况。结果三组患者性别、年龄等一般资料比较差异无统计学意义(P>0.05);三组患者使用桥接抗凝治疗比较差异无统计学意义(P>0.05)。三组患者应用抗栓药物病因、抗栓药物应用时间、术前停药时间、术后恢复用药时间比较差异有统计学意义(P<0.05)。抗栓药物病因中,正常组中高血压及冠心病所占比例最高,为67.16%;出血组和栓塞组中冠心病支架置入术后所占比例最高,分别为50.00%、66.67%。抗栓药物应用时间中,栓塞组应用时间6个月~1年比例最高,为77.78%;出血组应用时间>5年比例最高,为83.33%。术前停药时间中,正常组术前3~7 d停药比例最高,为53.73%;出血组术前0~2 d停药比例最高,为50.00%;栓塞组术前>7 d停药比例最高,为44.44%。术后恢复用药时间中,正常组术后3~7 d恢复用药比例最高,为34.33%;出血组0~2 d及3~7 d恢复用药比例均较高,均为33.33%;栓塞组术后>7 d恢复用药比例最高,为77.78%。出血组和栓塞组息肉大小≥2 cm比例分别为83.33%、66.67%,高于正常组的28.36%,差异有统计学意义(P<0.05);三组患者息肉位置比较差异无统计学意义(P>0.05)。结论抗栓治疗老年患者行内镜下结肠息肉切除术有一定风险,会导致患者术后发生出血和血栓,尤其对术前抗凝药物应用时间长、术中摘除息肉直径较大的患者风险尤为明显,临床应增加对此类患者的术后监护,并予以一定的预防措施。

Objective To study the safety of endoscopic colonic polypectomy in elderly patients treated with antithrombotic therapy.Methods The clinical data of 410 elderly patients undergoing endoscopic colonic polypectomy treated with antithrombotic therapy were retrospectively analyzed.The patients were divided into normal group(335 cases,no bleeding and embolization events),bleeding group(30 cases,bleeding events),and embolization group(45 cases,embolization events)according to whether there were adverse events such as bleeding and embolism after surgery.The baseline data,antithrombotic drug use and polyp related information of the three groups were compared.Results There was no statistically significant difference in gender,age and other general information among the three groups(P>0.05).There was no statistically significant difference in bridging anticoagulation among the three groups(P>0.05).The etiology of antithrombotic drug application,time of antithrombotic drug application,time of discontinuation of antithrombotic drugs before surgery,and time of resumption of antithrombotic drugs after surgery were compared among the three groups,and the differences were statistically significant(P<0.05).In etiology of antithrombotic drug application,the proportion of patients with hypertension and coronary heart disease was the highest in the normal group(67.16%),and the proportion of patients with coronary heart disease after stenting was the highest in the bleeding group(50.00%)and the embolization group(66.67%).In time of antithrombotic drug application,the highest proportion of 6 months to 1 year was in the embolization group(77.78%),and the highest proportion of>5 years was in the bleeding group(83.33%).In time of discontinuation of antithrombotic drugs before surgery,the proportion of drug discontinuation of antithrombotic drugs 3-7 d before surgery was the highest in the normal group(53.73%),the proportion of discontinuation of antithrombotic drugs 0-2 d before surgery was the highest in the bleeding group(50.00%),and the proportion of discontinuation of antithrombotic drugs>7 d before surgery was the highest in the embolization group(44.44%).In time of resumption of antithrombotic drugs after surgery,The proportion of resumption of antithrombotic drugs 3-7 d after surgery was highest in the normal group(34.33%),the proportion of resumption of antithrombotic drugs 0-2 d and 3-7 d was highest in bleeding group(both 33.33%),and the proportion of resumption of antithrombotic drugs>7 d was highest in the embolization group(77.78%).The proportion of polyps with size≥2 cm were 83.33%and 66.67%in the bleeding group and embolization group,which was higher than that of 28.36%in the normal group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the location of polyps among the three groups(P>0.05).Conclusion Endoscopic colon polypectomy for elderly patients treated with antithrombotic therapy has a certain risk,which will lead to bleeding and thrombus after surgery,especially for patients with long application time of antithrombotic drug before surgery and large diameter of polyps removed during surgery.Therefore,postoperative monitoring of such patients should be increased and certain preventive measures should be taken.