10 mm以下结直肠息肉内镜下黏膜切除术后迟发性出血影响因素及金属夹预防效果分析

Influencing factors of delayed bleeding after endoscopic mucosal resection ofcolorectal polyps less than 10 mm and prevention effect of metal clips

目的:分析10 mm以下结直肠息肉内镜下黏膜切除术(EMR)后迟发性出血的影响因素及金属夹的预防效果。方法:回顾性收集接受EMR治疗的10 mm以下结直肠息肉患者92例,根据术中是否留置金属夹分为留置组(50例)与未留置组(42例)。收集两组一般资料及术后迟发性出血情况并进行比较。根据术后迟发性出血情况将患者分为出血组(12例)与未出血组(80例)。通过单因素和多因素Logistic回归方程分析10 mm以下结直肠息肉患者EMR术后迟发性出血的影响因素。结果:留置组术后迟发性出血比例低于未留置组(P<0.05)。出血组年龄、高血压比例、长期抗凝药物服用史比例、息肉直径及无蒂息肉比例较未出血组高,金属夹使用比例较未出血组低(均P<0.05)。Logistic回归分析显示,对于10 mm以下结直肠息肉患者,高血压、长期抗凝药物服用史、息肉直径大及息肉无蒂是EMR术后迟发性出血的独立危险因素,而应用金属夹是其保护因素(均P<0.05)。结论:10 mm以下结直肠息肉患者合并高血压、长期抗凝药物服用史,以及其息肉直径大和息肉无蒂,均可导致其EMR术后迟发性出血发生风险升高,而在术中留置金属夹有利于降低其术后迟发性出血发生风险。

Objective:To analyze the influencing factors of delayed bleeding after endoscopic mucosal resection(EMR)of colorectal polyps less than 10 mm and prevention effect of metal clips.Methods:A total of 92 patients with colorectal polyps less than 10 mm who received EMR were retrospectively collected and divided into indwelling group(50 cases)and non-indwelling group(42 cases)according to whether metal clips were retained during the operation.General information and the incidence of postoperative delayed bleeding were collected and compared between the two groups.The patients were divided into bleeding group(12 cases)and non-bleeding group(80 cases)according to the presence or absence of postoperative delayed bleeding.The factors influencing delayed hemorrhage after EMR in patients with colorectal polyps less than 10 mm were analyzed by univariate and multivariate Logistic regression equations.Results:The incidence of postoperative delayed bleeding in the indwelling group after EMR was lower than that in the non-indwelling group(P<0.05).Age,the proportions of patients with hypertension and history of long-term anticoagulant use,polyp diameter,and the proportion of sessile polyps in the bleeding group were higher than those in the non-bleeding group,and the proportion of patients using metal clips was lower than that in the non-bleeding group(all P<0.05).Logistic regression analysis showed that hypertension,history of long-term anticoagulant use,and large polyp diameter and sessile polyps were independent risk factors for postoperative delayed bleeding in patients with colorectal polyps less than 10 mm after EMR,while the use of metal clips was a protective factor(all P<0.05).Conclusion:Concomitant hypertension,history of long-term anticoagulant use,large polyp diameter and sessile polyps all can increase the risk of postoperative delayed bleeding in patients with colorectal polyps less than 10 mm after EMR.Indwelling metal clips during operation can help to reduce the risk of postoperative delayed bleeding.