老年患者内镜下结直肠息肉切除术后迟发性出血危险因素分析

Risk factors of postoperative delayed hemorrhage in elderly patients receiving endoscopic colorectal polypectomy

目的分析老年患者内镜下结直肠息肉切除术后迟发性出血的危险因素和处理方法。方法回顾性分析2013年5月至2018年5月在广东医学院第二附属医院接受内镜下电凝电切术的614例结直肠息肉老年患者的病历资料,其中62例出现术后迟发性出血的患者为观察组,余552例术后无出血的患者为对照组。分析迟发性出血的发生原因、危险因素和治疗方法。结果观察组与对照组比较,年龄[≥70岁:38. 7%(24/62)比10. 9%(60/552)]、息肉直径[≥1 cm:69. 4%(43/62)比53. 6%(296/552)]、息肉形态[无蒂:16. 1%(10/62)比6. 5%(36/552)]、术中出血量[≥50 ml:35. 5%(22/62)比10. 5%(58/552)]差异均有统计学意义(均P <0. 05),以上因素均是内镜下电凝电切术后迟发性出血的危险因素;性别、息肉部位、息肉数量、合并症对迟发性出血无明显影响(均P> 0. 05)。出血患者均经内镜处理成功止血,无需中转外科手术。结论老年患者内镜下结直肠息肉切除术后迟发性出血与年龄、息肉直径、息肉形态、术中出血量有关,内镜下止血是有效处理方法。

Objective To analyze the risk factors and therapeutic methods of postoperative delayed hemorrhage in elderly patients receiving endoscopic colorectal polypectomy. Methods Clinical data of 614 elderly patients who had endoscopic electrocoagulation and electrotomy of colorectal polyps in the Second Affiliated Hospital of Guangdong Medical University from May 2013 to May 2018 were retrospectively analyzed;62 cases with delayed hemorrhage after operation were observation group;552 cases without postoperative hemorrhage were control group. Causes, risk factors of hemorrhage and treatment measures were analyzed. Results Age[≥70 years old: 38. 7%( 24/62) vs 10. 9%( 60/552) ],diameter of polyps[≥1 cm: 69. 4%( 43/62) vs53. 6%( 296/552) ],shape of polyps[non-pedicle: 16. 1%( 10/62) vs 6. 5%( 36/552) ] and intraoperative bleeding volume[≥50 ml: 35. 5%( 22/62) vs 10. 5%( 58/552) ] showed significant differences between the observation group and control group( P < 0. 05). Sex,site of polyps,amount of polyps and comorbidities showed no significant difference between groups( P > 0. 05). Successful hemostasis was obtained through endoscopic treatments in all patients. Conclusions Age,diameter of polyps,shape of polyps and intraoperative bleeding volume are risk factors of delayed hemorrhage after endoscopic colorectal polypectomy in elderly patients.Endoscopic hemostasis is effective in the treatment of delayed hemorrhage.