结直肠息肉内镜下电凝电切术后迟发性出血68例分析  

Analysis of 68 patients with delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope

作　　者：陈兰[1] 文峰[2] 余卫中[1] 夏伶俐[1] 肖丹[1] 

机构地区：[1]江汉大学附属医院武汉市第六医院消化内科,武汉430015 [2]解放军161医院消化内科

出　　处：《西南国防医药》2016年第3期255-257,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨结直肠息肉电凝电切术后迟发性出血的临床特征及危险因素,为其防治提供参考。方法以电凝电切术后发生迟发性出血的结直肠息肉患者68例为观察组,同期经电凝电切治疗但未发生迟发性出血的结直肠息肉患者1986例为对照组,分析观察组临床特征、息肉特征、预后及迟发性出血的相关危险因素。结果出血发生在电凝电切术后2 h^28 d不等,其中大便中带血16例,便鲜血52例;一次便血量≤50 ml者26例,50~100 ml者18例,101~200 ml者6例,>200 ml者2例。68例中,单发息肉26例,多发42例;术后出血息肉最大直径≥10 mm的48例,<10 mm的20例;有蒂息肉8例,亚蒂息肉13例,无蒂及平坦型息肉47例;术后病理类型:炎性增生性息肉16例,腺瘤52例。均经肠镜下成功止血。年龄≥60岁、合并高血压、冠心病、糖尿病、长期口服抗凝药、长期透析、多发息肉、息肉≥1 cm、无蒂息肉、腺瘤性息肉为结直肠息肉电凝电切术后迟发性出血的危险因素。结论结直肠息肉内镜下电凝电切治疗后迟发性出血患者以高龄及合并高血压者为主,可发生于术后2 h^4 w内,多为息肉较大的无蒂或扁平型息肉,病理类型多为腺瘤。内镜下止血是治疗迟发性出血的重要方法。Objective To explore the clinical characteristics and risk factors of patients with delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope in order to provide references for the prevention and treatment.Methods 68 patients with delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope were chosen as observation group, and 1986 patients without delayed hemorrhage after the coagulation and electrotomy at the same time period were regarded as control group. Analysis was made in the clinical characteristics, polyps condition, prognosis, and correlated risk factors of delayed hemorrhage in the observation group. The risk factors of delayed hemorrhage were analyzed. Results Bleeding occurred 2 h to 28 d after the operation. There were 16 cases with bloody stool and 52 ones of stooling blood. There were 26 cases with the bleeding ≤50 ml, 18 ones with the bleeding of 50-100 ml, 6 ones with the volume of 101-200 ml, and 2 more than 200 ml.Among the 68 cases, there were 26 cases of single polyp, 42 ones of multiple polyps. After the operation, 48 cases had the maximum diameter of the bleed polyps ≥ 10 mm, and 20 patients had that 〈10 mm. There were 8 patients with pedunculated polyps, 13 ones with sub-pedunculated polyps, and 47 patients with non-pedunculated or flat polyps. The postoperative pathological detection showed16 patients with inflammatory hyperplasia polyps and 52 ones with adenoma. All the 68 patients obtained successful hemostasis under endoscope. The risk factors included age ≥60, complicated hypertension, coronary heart disease, diabetes, long- term oral administration with anticoagulants, long term dialysis, multiple polyps, polyp diameter ≥1 cm, sessile polyps, and adenoma polyps.Conclusion Patients with delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope are mainly elderly people and the ones complicated with hypertension. The delayed hemorrhage may occur 2 h to

关 键 词：结直肠 息肉 电凝电切 迟发性出血 危险因素 

分 类 号：R574.62[医药卫生—消化系统]