预防性放置钛夹对结直肠息肉内镜下黏膜切除术后迟发性出血的影响研究  

Study on effect of prophylactic titanium clip placement for delayed bleeding after endoscopic mucosal resection of colorectal polyps

作　　者：叶依霞 司徒树标 倪东升 YE Yi-xia;SITU Shu-biao;NI Dong-sheng(Department of Gastroenterology,Liwan Central Hospital,Guangzhou 510000,China)

机构地区：[1]广州市荔湾中心医院消化内科,510000

出　　处：《中国实用医药》2021年第25期39-41,共3页China Practical Medicine

摘　　要：目的研究预防性放置钛夹对结肠息肉内镜下黏膜切除术(EMR)后迟发性出血的影响。方法196例结直肠息肉直径≥10 mm且无蒂患者,按照随机数字表法分为治疗组(97例)和对照组(99例)。两组患者均接受EMR术,治疗组予钛夹夹闭创面,对照组则不使用钛夹。比较两组迟发性出血发生、再次行肠镜检查镜下有活动出血、输注红细胞治疗情况。结果所有患者肠镜检查过程均顺利,治疗组患者术后有2例发生迟发性出血(2.06%),对照组术后有9例发生迟发性出血(9.09%),治疗组迟发性出血发生率低于对照组,差异具有统计学意义(P<0.05)。这11例患者入院后,均再次行肠镜检查,对照组有7例患者镜下有活动出血,予钛夹夹闭止血,另外4例患者无镜下活动出血,未予镜下止血处理,禁食2~3 d后观察无活动出血后予出院。对照组需内镜下止血占比7.07%高于治疗组的0,差异具有统计学意义(P<0.05)。所有患者出院后随访30 d无再出血。所有出血的患者中,均不需要外科进行处理,其中对照组有1例患者因出血量较多,予输注红细胞治疗,两组术后需输注红细胞情况比较差异无统计学意义(P>0.05)。所有患者在随访半年后复查肠镜,均无复发和病变残留。结论对直径≥10 mm的无蒂结直肠息肉,EMR术后预防性放置钛夹有利于减少术后迟发性出血的发生。Objective To study the effect of prophylactic titanium clip placement for delayed bleeding after endoscopic mucosal resection(EMR)of colorectal polyps.Methods A total of 196 patients with non-pedunculated colorectal polyps were divided into treatment group(97 cases)and control group(99 cases)according to random numerical table.Patients in both groups were treated with MER.Patients in the treatment group received prophylactic placement of titanium clip,while patients in the control group did not receive titanium clip.The occurrence of delayed bleeding,active bleeding under enteroscopy and red blood cell infusion were observed.Results All patients underwent colonoscopy smoothly.Delayed bleeding occurred in 2 cases(2.06%)in the treatment group and 9 cases in the control group(9.09%).The incidence of delayed bleeding in the treatment group was lower than that in the control group,and the difference was statistically significant(P<0.05).After admission,11 patients underwent enteroscopy again.The proportion of active bleeding under enteroscopy of the control group was 7.07%,which was higher than 0 of the treatment group,and the difference was statistically significant(P<0.05).In the control group,7 patients had active bleeding under the enteroscopy,and were clamped with titanium clips to stop bleeding.The other 4 patients had no active bleeding under the enteroscopy and were not treated with hemostasis under the enteroscopy.They were observed after fasting for 2-3 d and were discharged from hospital after no active bleeding.The percentage of requiring endoscopic hemostasis in the control group was 7.07%,which was higher than 0 in the treatment group,and the difference was statistically significant(P<0.05).All patients were followed up for 30 d without rebleeding.All patients with bleeding did not require surgical treatment.1 patient in the control group was treated with red blood cell infusion due to heavy bleeding,and the difference between the two groups requiring postoperative red blood cell transfusion was not stat

关 键 词：结肠息肉内镜下黏膜切除术 预防性放置钛夹 迟发性出血 

分 类 号：R735.34[医药卫生—肿瘤]