大肠息肉内镜下黏膜切除术后出血的危险因素分析  

Risk factors for hemorrhage after endoscopic mucosal resection for colorectal polyp

作　　者：金卉[1] 李信[1] 韦荣芬[1] 梁洁[1] 莫素娟 覃俭福 JIN Hui;LI Xin;WEI Rong-fen;LIANG Jie;MO Su-juan;QIN Jian-fu(Department of Gastroenterology,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China)

机构地区：[1]广西医科大学第二附属医院消化内科,南宁市530007

出　　处：《广西医学》2018年第5期496-499,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2012144)

摘　　要：目的探讨大肠息肉内镜下黏膜切除术(EMR)后并发出血的相关危险因素。方法行EMR治疗的大肠息肉患者947例,其中术后并发出血42例,未出血905例,采用logistic回归分析方法对可能影响术后出血的相关危险因素进行分析。结果单因素分析结果显示:患者性别、切除息肉颗数、术中出血、术者职称、术后进食时间、息肉形状、息肉外观、息肉有无分叶、息肉部位、病理类型与术后出血有关(P<0.05);患者年龄、息肉直径、术中是否使用钛夹止血与术后出血无关(P>0.05)。多因素非条件logistic回归分析结果显示:术后48 h内进食、同次切除息肉≥4颗、息肉外观潮红糜烂、术者副高级职称、息肉分叶状是EMR切除大肠息肉术后出血的独立危险因素(P<0.05)。结论术后48 h内进食、同次切除息肉≥4颗、息肉外观潮红糜烂、术者副高级职称、息肉分叶状是EMR切除大肠息肉术后出血的独立危险因素,应针对相关危险因素进行预防和干预,以降低术后出血的发生率。Objective To investigate the related risk factors for hemorrhage after endoscopic mucosal resection(EMR)for colorectal polyp.Methods A total of 947 patients with colorectal polyp scheduled for EMR included 42 cases complicated with postoperative hemorrhage and 905 cases without postoperative hemorrhage.Logistic regression was used to analyze the related risk factors possibly influencing postoperative hemorrhage.Results The result of univariate analysis showed that patient′s gender,number of excised polyps,intraoperative hemorrhage,operator′s professional title,time to postoperative eating,and morphology,appearance,lobulation,site and pathological type of polyp correlated with postoperative hemorrhage(P<0.05);and patient′s age,diameter of polyp,and intraoperative hemostasis using titanium clip did not correlate with postoperative hemorrhage(P>0.05).The result of multivariate logistic regression analysis showed that eating within 48 hours after the operation,number of excised polyps more than 4 once,polyp′s appearance being flushing and erosion,deputy senior operator,lobulated polyps were independent risk factors for hemorrhage after EMR for colorectal polyp(P<0.05).Conclusion Eating within 48 hours after the operation,number of excised polyps more than 4 once,polyp′s appearance being flushing and erosion,deputy senior operator,lobulated polyps are independent risk factors for hemorrhage after EMR for colorectal polyp.It should carry out the prevention and intervention of related risk factors to reduce the incidence rate of postoperative hemorrhage.

关 键 词：结肠息肉 内镜下黏膜切除术 术后出血 危险因素 并发症 

分 类 号：R574[医药卫生—消化系统]