内镜下结直肠腺瘤性息肉的特征及经切除术后迟发出血的危险因素分析  

Characteristics of colorectal adenomatous polyps under endoscopy and analysis of risk factors for delayed bleeding after resection

作　　者：王敏[1] 韦雪连 李常伟 周源 游欣 孙娟 WANG Min;WEI Xuelian;LI Changwei;ZHOU Yuan;YOU Xin;SUN Juan(Department of Gastroenterology,the Affiliated Dazu′s Hospital of Chongqing Medical University,Chongqing 402360,China;Department of Anus and Intesine,the Affiliated Dazu′s Hospital of Chongqing Medical University,Chongqing 402360,China)

机构地区：[1]重庆医科大学附属大足医院消化内科,重庆402360 [2]重庆医科大学附属大足医院肛肠外科,重庆402360

出　　处：《胃肠病学和肝病学杂志》2024年第6期714-718,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：重庆市大足区科技发展项目(DZKJ,2019ACC1002)。

摘　　要：目的探讨内镜下结直肠腺瘤性息肉的特征及经切除术后迟发出血的危险因素,为临床诊治提供依据。方法选取2019年2月至2021年5月我院消化内科收治的1604例行EMR的结直肠腺瘤性息肉患者为研究对象。按照术后是否出现迟发性出血,分为出血组(n=35)和非出血组(n=1569)。统计患者一般资料、EMR切除息肉的情况、EMR操作情况;采用Logistic多因素分析内镜下结直肠腺瘤性息肉患者经切除术后迟发出血的危险因素,并建立列线图模型给予评价。结果两组在吸烟史、淋巴细胞数、息肉山田分型为Ⅲ型、息肉最大基底直径、钛夹缝合后稀疏、创面覆盖不全及倒伏方面比较,差异有统计学意义(P<0.05)。Logistic多因素分析结果显示,长期吸烟、淋巴细胞数≥3.65×10^(9)L^(-1)、息肉山田分型为Ⅲ型、息肉最大基底直径≥0.98 cm、钛夹倒伏是结直肠腺瘤性息肉患者术后出现迟发性出血情况的独立危险因素。列线图模型预测效果良好,且上述因素预测术后迟发出血的AUC分别为0.652、0.649、0.759、0.687、0.705,而列线图模型的AUC为0.799。采用Bootstrap法重复抽样1000次获得AUC为72.1%(95%CI:64.3%~81.6%)。校正曲线显示,该模型具备较好的一致性。用Hosmer-Lemeshow检验分别判断模型的拟合优度,结果显示模型的P值为0.482;绘制DCA曲线显示,与单一因素相比,列线图模型具有更好的临床获益度。结论内镜下结直肠腺瘤性息肉具有息肉山田分型为Ⅲ型、息肉最大基底直径≥0.98 cm、钛夹倒伏的特征,以及有吸烟史、淋巴细胞数≥3.65×10^(9)L^(-1)的患者对于迟发性出血应加以防范。Objective To explore the characteristics of colorectal adenomatous polyps under endoscopy and the risk factors of delayed bleeding after resection,and provide scientific guidance for clinical practice.Methods Selected 1604 patients with colorectal adenomatous polyps who underwent EMR who were admitted to the Department of Gastroenterology of our hospital from Feb.2019 to May 2021 as the research objects.According to whether there was delayed bleeding after operation,they were divided into bleeding group(n=35)and non-bleeding group(n=1569).Patients′general information,EMR resection of polyps,EMR operation status were counted.Logistic multivariate analysis of the risk factors of delayed bleeding in patients with colorectal adenomatous polyps after resection under endoscopy,and establishment of a nomogram model for evaluation.Results Statistically significant differences were observed between the two groups in terms of smoking history,lymphocyte count,Yamada polyp typeⅢ,maximum basal diameter of polyps,sparseness after suture with titanium clips,incomplete wound coverage and lodging(P<0.05).Logistic multivariate analysis showed that long-term smoking,lymphocyte count≥3.65×10^(9)L^(-1),Yamada polyp typeⅢ,polyp maximum basal diameter≥0.98 cm,and titanium clip lodging as independent risk factors for delayed bleeding.The predictive effect of the nomogram model was good,and the above factors predict the AUC of delayed bleeding after operation were 0.652,0.649,0.759,0.687,0.705,and the AUC of the nomogram model was 0.799.Using the Bootstrap method to sample 1000 times repeatedly,the AUC was 72.1%(95%CI:64.3%-81.6%).The calibration curve showed that the model had good consistency.The Hosmer-Lemeshow test was used to judge the goodness of fit of the model.The results showed that the P value of the model was 0.482.The DCA curve was drawn to show that the nomogram model had better clinical benefit than a single factor.Conclusion Colorectal adenomatous polyps under endoscopy exhibit specific characteristics that may

关 键 词：结直肠腺瘤性息肉 特征 内镜下黏膜切除术 术后迟发出血 危险因素 

分 类 号：R576[医药卫生—消化系统]