内镜下治疗延迟性出血的相关危险因素分析

Analysis of risk factors associated with endoscopic treatment of delayed hemorrhage

摘要:

摘要：目的 探讨内镜下治疗术后延迟性出血的情况及其相关危险因素。方法 收集该院2008年6月－2018年6月因消化道病变行内镜黏膜下剥离术（ESD）、内镜下黏膜切除术（EMR）和氩离子凝固术（APC）治疗而发生术后延迟性出血的76例患者资料，回顾性分析相关临床、内镜及病理资料。在每例发生术后延迟性出血的患者的治疗期间，选择在同等条件下经内镜治疗术后未发生延迟性出血的患者中，选取76例样本作为对照组进行回顾性分析，记录患者的相关临床、内镜及病理资料。统计分析以下相关因素：①患者相关因素：性别、年龄、基础疾病和抗凝剂服用情况；②病变相关因素：病变部位及大小、生长方式和组织类型；③操作相关因素：操作者熟练程度、手术时间等因素。结果 10年内该院发生术后延迟性出血的患者共76例，占全部内镜下治疗患者人数的1.25‰。术后延迟性出血多见于男性，且年龄普遍较大。基础疾病的存在，如肝硬化、糖尿病以及高血压等影响内外源性凝血系统以及凝血因子生成的相关疾病，增加了患者术后延迟性出血的风险。术后延迟性出血在结肠中的占比最高，病变大小与术后延迟性出血存在正相关，直肠、胃底等双重血供部位增加了其风险。相对于间质瘤、炎性病变和平滑肌瘤等病变，腺瘤性病变术后延迟性出血的风险最高。随着手术时间增加，发生术后延迟性出血的风险不断增加，这同时与术者的熟练程度关系密切。结论 基础疾病、病变部位及大小、组织类型、手术时间及术者操作者熟练程度是内镜下治疗术后延迟性出血的危险因素。

Abstract:

Abstract: Objective To investigate the situation and related risk factors of delayed postoperative hemorrhage after the endoscopic treations. Methods We retrospectively analyzed the clinical data, endoscopic surgical data and pathological data of the patients who had endoscopic mucosal dissection (ESD)/mucosal resection (EMR)/argon knife coagulation (APC) due to digestive tract lesions from June 2008 to June 2018, at the same time, among the patients who did not have delayed bleeding after endoscopic treatment under the same conditions, we selected samples randomly and formed a control group to analyze the clinical, endoscopic and pathological data of the patients in the control group. The following factors were statistically analyzed: related factors of patients: age, gender, anticoagulants; related factors of diseases: lesion size, lesion location, growth mode, tissue type; factors related to the operator’s proficiency and operation time. Results In this study, delayed hemorrhage mainly occurred in the dual-blood supply, and the site of abundant blood flow per unit time, mainly in males. Meanwhile, it was more common in the elderly in terms of age. Liver cirrhosis, diabetes, hypertension, hematological diseases and other related diseases, such as endogenous coagulation system, coagulation factor formation and platelet dysplasia, can increase the risk of delayed hemorrhage after endoscopic treatment. Compared with interstitial tumor, papilloma, inflammatory hyperplastic polyp, leiomyoma, and high-grade intrepithelial neoplasia, the risk of delayed hemorrhage of adenomatous disease is significantly increased, which is related to the abundance of blood supply in lesions. With the increase of operation time, we found that patients had an increased risk of delayed hemorrhage after surgery and were affected by the difficulty of surgery and operator proficiency. In terms of growth pattern, we found that the risk of delayed hemorrhage is the highest, which may be related to the need for submucosal injection of methylene blue and other related drugs to cause local mucosal swelling and increase the risk of surgical wound and blood vessel exposure under the same conditions. Conclusions Basic diseases, lesion location, lesion size, tissue type, operation time and operator proficiency are independent risk factors for delayed hemorrhage after endoscopic surgery.