结直肠息肉切除术后迟发性出血的危险因素分析

Risk factors of delayed bleeding after endoscopic mucosal resection

摘要:

目的 探讨结直肠息肉内镜下黏膜切除术（EMR）后迟发性出血的危险因素。方法 选取2017年9月－2019年9月于苏州大学附属第二医院消化内科行EMR的结直肠息肉患者825例，对纳入患者的基本信息和息肉特征进行单因素及多因素回归分析。结果 825例患者中有33例（4.0%）出现迟发性出血。单因素分析显示，年龄（P = 0.000）、高血压病史（P = 0.013）、术中出血（P = 0.000）、息肉部位（P = 0.026）、息肉大小（P = 0.014）、息肉形态（P = 0.042）和息肉病理（P = 0.044）是迟发性出血的危险因素。多因素分析显示，高血压（P = 0.003，O = 3.266，95%CI：1.485～7.187）、术中出血（P = 0.000，O = 39.630，95%CI：14.031～111.935）和息肉直径 ≥ 10 mm（P = 0.014，O = 2.725，95%CI：1.223～6.069）是迟发性出血的独立危险因素。结论 高血压病史、术中出血和息肉直径≥10 mm与迟发性出血密切相关，提前预防可减少迟发性出血的发生。

Abstract:

Objective To analyze risk factors of delayed postpolypectomy bleeding (DPPB) after endoscopic mucosal resection.Methods 825 patients underwent colonoscopy polypectomy from September 2017 to September 2019 were involved in this study. The clinical data, polyp location, polyp pathology, polyp size, polyp number and morphology were analyzed using univariate and multivariate logistic analysis.Results 33 (4.0%) colorectal polyps in 825 patients presented with delayed bleeding. Univariate analysis indicated that age (P = 0.000), hypertension (P = 0.013), intraoperative bleeding (P = 0.000), polyp location (P = 0.026), size (P = 0.014), morphology (P = 0.042), pathology (P = 0.044) were risk factors for DPPB. Multivariate logistic analysis indicated that hypertension (P = 0.003, O = 3.266, 95%CI: 1.485～7.187), intraoperative bleeding (P = 0.000, O = 39.630, 95%CI: 14.031～111.935), and a polyp size over 10 mm (P = 0.014, O = 2.725, 95%CI: 1.223～6.069) were independently associated with DPPB.Conclusion DPPB is significantly associated with hypertension, intraprocedural bleeding and polyp size ≥ 10 mm. Precautionary measures can reduce the risk of DPPB.