结直肠息肉经内镜下黏膜切除术后出血的危险因素分析
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摘要
目的探讨结直肠息肉内镜下黏膜切除(EMR)术后出血的相关危险因素。方法 833例接受EMR切除术的肠息肉患者作为研究对象,根据术后是否发生出血分为出血组(41例)和未出血组(792例),纳入基本人口学因素、病理因素及治疗因素作为单因素分析项目,采用Logistic多因素分析法探讨术后出血的高危因素。结果共41例患者发生术后出血,出血发生率为4.92%。单因素分析结果显示:性别、息肉直径、息肉形态、术中出血、禁食程度、息肉病理类型、钛夹数量、禁食时间可能与术后出血有关(P<0.05),其中男性、息肉直径>2cm、有蒂息肉、术中出血、息肉合并黏膜内癌或重度异性增生的患者术后出血风险更高;患者年龄、门诊或住院、术者技术水平、肠道清洁度、息肉发生部位、创面处理方式、息肉数量对术后出血无影响(P>0.05)。多因素非条件Logistic回归分析结果显示:男性、息肉直径>2cm、术中出血为EMR术后出血的独立危险因素(P<0.05),钛夹使用数量为保护因素(P<0.05)。结论肠息肉MER术后并发出血与性别、息肉直径、术中出血、钛夹数量明显相关,针对性预防、减少术中出血、增加夹闭创面的钛夹数量可以降低术后出血的发生。
Objective To discuss the risk factors of hemorrhage after endoscopic mucosal resection(EMR)of colorectal polyps. Methods A total of 833 patients with colorectal polyp scheduled for EMR were enrolled in this study and divided into bleeding group and non-bleeding group according to whether bleeding occcurred after EMR.Basic demographic factors,pathological factors and therapeutic factors were included as univariate analysis items.Logistic multivariate analysis was used to explore the high risk factors of postoperative bleeding. Results A total of 41 patients had postoperative bleeding,and the incidence of bleeding was 4.92%.The result of univariate analysis showed that patient's gender,diameter of polyp,morphology of polyp,intraoperative hemorrhage,degree of fasting,pathological type of polyp,number of titanium clip and time to postoperative eating were significantly correlated with postoperative hemorrhage(P<0.05);the patients with male,polyp diameter>2 cm,pedicle polyp,intraoperative hemorrhage and canceration or dysplasia of polyp have a higher risk of postoperative bleeding(P<0.05).Patient age,inpatient or outpatien,technical level of the surgeon,the intestinal cleanliness,location of polyp,method of wound treatment and number of excised polyps have no effect on postoperative hemorrhage(P>0.05).The results of multivariate Logistic regression analysis showed that male,polyp diameter>2 cm and intraoperative hemorrhage were independent risk factors for hemorrhage after EMR for colorectal polyp(P<0.05);and the number of titanium clips is a protective factor(P<0.05). Conclusion Bleeding after EMR for colorectal polyp were significantly related to patient's gender,diameter of polyp,intraoperative hemorrhage and the number of titanium clips used Targeted prevention,reduction of intraoperative hemorrhage and increased number of titanium clips of clipping wounds can reduce postoperative bleeding.
Objective To discuss the risk factors of hemorrhage after endoscopic mucosal resection(EMR)of colorectal polyps. Methods A total of 833 patients with colorectal polyp scheduled for EMR were enrolled in this study and divided into bleeding group and non-bleeding group according to whether bleeding occcurred after EMR.Basic demographic factors,pathological factors and therapeutic factors were included as univariate analysis items.Logistic multivariate analysis was used to explore the high risk factors of postoperative bleeding. Results A total of 41 patients had postoperative bleeding,and the incidence of bleeding was 4.92%.The result of univariate analysis showed that patient's gender,diameter of polyp,morphology of polyp,intraoperative hemorrhage,degree of fasting,pathological type of polyp,number of titanium clip and time to postoperative eating were significantly correlated with postoperative hemorrhage(P<0.05);the patients with male,polyp diameter>2 cm,pedicle polyp,intraoperative hemorrhage and canceration or dysplasia of polyp have a higher risk of postoperative bleeding(P<0.05).Patient age,inpatient or outpatien,technical level of the surgeon,the intestinal cleanliness,location of polyp,method of wound treatment and number of excised polyps have no effect on postoperative hemorrhage(P>0.05).The results of multivariate Logistic regression analysis showed that male,polyp diameter>2 cm and intraoperative hemorrhage were independent risk factors for hemorrhage after EMR for colorectal polyp(P<0.05);and the number of titanium clips is a protective factor(P<0.05). Conclusion Bleeding after EMR for colorectal polyp were significantly related to patient's gender,diameter of polyp,intraoperative hemorrhage and the number of titanium clips used Targeted prevention,reduction of intraoperative hemorrhage and increased number of titanium clips of clipping wounds can reduce postoperative bleeding.
引文
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[11]Rabeneck L,Paszat LF,Hilsden RJ,et al.Bleeding and perforation after outpatient colonoscopy and their risk fac tors in usual clinical practice[J].Gastroenterology,2008,135(6):1899-1906.
[12]Niikura R,Yasunaga H,Yamada A,et al.Factors predicting adverse events associated with therapeutic colonoscopy for colorectal neoplasia:a retrospective nationwide study in Japan[J].Gastrointest Endosc,2016,84(6):971-982.
[13]PigòF,Bertani H,Manno M,et al.Colonic postpolypectomy bleeding is related to polyp size and heparin use[J].Clin Endosc,2017,50(3):287-292.
[14]Park SK,Seo JY,Lee MG,et al.Prospective analysis of delayed colorectal post-polypectomy bleeding[J].Surg Endosc,2018,32(7):3282-3289.
[15]覃桂聪,黄璐,覃爱娜,等.结肠息肉内镜下治疗257例回顾性分析[J].广西医科大学学报,2015,32(3):487-489.
[16]Matsumoto M,Kato M,Oba K,et al.Multicenter randomized controlled study to assess the effect of prophylactic clipping on postpoly pectomy delayed bleeding[J].Dig Endosc,2016,28(5):570-576.
[17]Pohl H,Grimm IS,Moyer MT,et al.Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial[J].Gastroenterology,2019,pii:S0016-5085(19)33573-33575.
[2]彭琴.结直肠息肉经内镜摘除术后并发出血的危险因素分析[J].中国内镜杂志,2017,2(23):62-65.
[3]Ahlenstiel G,Hourigan LF,Brown G,et al.Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon[J].Gastrointest Endosc,2014,80(4):668-676.
[4]中华医学会消化内镜学分会,中华医学会麻醉学分会.中国无痛苦消化内镜应用指南(2013)[J].中国实用内科杂志,2014,34(1):32-36.
[5]Ferlitsch M,Moss A,Hassan C,et al.Colorectal polypectomy and endoscopic mucosal resection(EMR):European Society of Gastrointestinal Endoscopy(ESGE)clinical guideline[J].Endoscopy,2017,499(3):270-297.
[6]Lai EJ,Calderwood AH,Doros G,et al.The Boston bowel preparation scale:a valid and reliable instrument for colonoscopy-oriented research[J].Gastrointest Endosc,2009,69(3Pt2):620-625.
[7]李培培,王宇晴,倪永,等.结直肠息肉内镜下黏膜切除术后出血的危险因素分析[J].南京医科大学学报(自然科学版),2019,3(39):360-374.
[8]Townsend CM.Sabiston textbook of surgery[J].Elevier-Saunders,2004:1455-1456.
[9]Liu C,Wu R,Sun X,et al.Risk factors for delayed hemorrhage after colonoscopic postpolypectomy[J].JGH Open,2018,3(1):61-64.
[10]金卉,李信,韦荣芬,等.大肠息肉内镜下黏膜切除术后出血的危险因素分析[J].广西医学,2018,5(40):496-499.
[11]Rabeneck L,Paszat LF,Hilsden RJ,et al.Bleeding and perforation after outpatient colonoscopy and their risk fac tors in usual clinical practice[J].Gastroenterology,2008,135(6):1899-1906.
[12]Niikura R,Yasunaga H,Yamada A,et al.Factors predicting adverse events associated with therapeutic colonoscopy for colorectal neoplasia:a retrospective nationwide study in Japan[J].Gastrointest Endosc,2016,84(6):971-982.
[13]PigòF,Bertani H,Manno M,et al.Colonic postpolypectomy bleeding is related to polyp size and heparin use[J].Clin Endosc,2017,50(3):287-292.
[14]Park SK,Seo JY,Lee MG,et al.Prospective analysis of delayed colorectal post-polypectomy bleeding[J].Surg Endosc,2018,32(7):3282-3289.
[15]覃桂聪,黄璐,覃爱娜,等.结肠息肉内镜下治疗257例回顾性分析[J].广西医科大学学报,2015,32(3):487-489.
[16]Matsumoto M,Kato M,Oba K,et al.Multicenter randomized controlled study to assess the effect of prophylactic clipping on postpoly pectomy delayed bleeding[J].Dig Endosc,2016,28(5):570-576.
[17]Pohl H,Grimm IS,Moyer MT,et al.Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial[J].Gastroenterology,2019,pii:S0016-5085(19)33573-33575.