胃炎性纤维性息肉发生消化道出血的临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of gastrointestinal hemorrhage in gastric inflammatory fibroid polyp

摘要:

目的 研究胃炎性纤维性息肉（GIFP）发生消化道出血的危险因素及临床特征。方法 回顾性分析2013年1月1日－2022年9月30日该院66例（共68处病变）经内镜下切除或外科手术切除，病理确诊为GIFP的患者的临床资料，根据有无消化道出血，分为出血组（n = 16）和未出血组（n = 50）。收集两组患者性别、年龄、临床表现、病变部位、大小、内镜下特征、幽门螺杆菌感染情况、手术方式和病理结果等临床资料。采用单因素及多因素Logistic回归分析GIFP发生消化道出血的危险因素，总结发生消化道出血的GIFP临床特征，并计算术前正确诊断率。结果 出血组发病年龄明显小于未出血组，病灶大小明显大于未出血组，差异均有统计学意义（P < 0.05）；出血组病灶内镜下呈新生物样隆起、表面伴有糜烂或溃疡、伴有球阀综合征和超声内镜有血流信号影的发生率明显高于未出血组，差异均有统计学意义（P < 0.05）；两组患者其他指标比较，差异无统计学意义（P > 0.05）。采用多因素Logistic回归分析发现，病灶呈新生物样隆起或黏膜下隆起、表面有溃疡或糜烂和伴有球阀综合征，是GIFP发生消化道出血的独立危险因素（OR＾ > 1，P < 0.05）。术前GIFP总体正确诊断率为27.94%。术前行超声内镜的患者，术前正确诊断率为38.78%，明显高于未行超声内镜的患者（χ² = 20.82，P = 0.000）。结论 病灶形态、表面有溃疡或糜烂和伴有球阀综合征，是GIFP发生消化道出血的独立危险因素。术前行超声内镜检查术，有利于提高术前正确诊断率。当GIFP有发生消化道出血风险时，应及早行内镜下诊断和治疗性切除术，以避免不必要的外科手术，且有助于改善预后，提高患者生活质量。

Abstract:

Objective To investigate the risk factors and clinical characteristics of gastric inflammatory fibroid polyp (GIFP) for gastrointestinal hemorrhage.Methods 66 patients (68 lesions in total) with GIFP diagnosed by endoscopic or surgical resection from January 1, 2013 to September 30, 2022 were collected. According to the presence or absence of gastrointestinal hemorrhage, the patients were divided into bleeding group (n = 16) and non-bleeding group (n = 50). Collect clinical data on gender, age, clinical manifestations, lesion location and size, endoscopic characteristics, Helicobacter pylori infection, surgical methods and pathological results of each group of patients. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of endoscopic characteristics of GIFP for gastrointestinal hemorrhage, and summarize the clinical characteristics of GIFP with gastrointestinal hemorrhage, then calculate the rate of correct diagnosis.Results The age of the bleeding group was significantly younger than that of the non-bleeding group, and the lesion size was significantly larger than that of the non-bleeding group, with statistically significant differences (P < 0.05). The incidences of endoscopic neoplasm-like elevation of lesions, surface with erosion or ulceration, accompanied by ballvalve syndrome and ultrasonic gastroscopy with blood flow signals in the bleeding group were significantly higher than those in the non-bleeding group, and the differences were statistically significant (P < 0.05), but there were no statistical differences in other indicators between the two groups (P > 0.05). In order to further investigate the relationship between endoscopic characteristics and gastrointestinal hemorrhage, multivariate Logistic regression analysis showed that neoplasm-like elevation, submucosal eminence, ulcer or erosion on the surface and ball valve syndrome were risk factors for gastrointestinal hemorrhage in GIFP (OR＾ > 1, P < 0.05). The overall rate of GIFP correct diagnosis before surgery was 27.94%. The rate of diagnosis in patients echoendoscope before surgery was 38.78%, it was significantly higher than that without undergoing echoendoscope (χ² = 20.82, P = 0.000).Conclusion The shape of the lesion, presence of ulcers or erosion on the surface, and presence of ball valve syndrome are risk factors for gastrointestinal hemorrhage. Preoperative endoscopic ultrasonography can improve the accuracy of preoperative diagnosis. When there is a risk of gastrointestinal hemorrhage in GIFP, early endoscopic diagnosis and therapeutic resection should be performed to avoid unnecessary surgical procedures, which can improve prognosis and improve patient quality of life.