结直肠息肉内镜下黏膜切除术后出血的危险因素分析
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摘要
目的:消化道出血是结直肠息肉切除术后最常见的并发症,本研究探讨结直肠息肉内镜下黏膜切除(endoscopic mucosal resection,EMR)术后出血的相关危险因素。方法:回顾性分析111例结直肠息肉EMR术后出血的患者和176例未出血患者的临床资料。结果:单因素分析显示,共有5个变量对结直肠息肉EMR术后出血的影响有统计学意义,分别为男性(P=0.008)、息肉数目(≥3枚)(P=0.001)、息肉直径(≥10 mm)(P <0.001)、息肉分布部位(右半结肠)(P=0.036)、抗栓药的使用(P=0.015)。对上述5个变量及高血压(P <0.1)、病理类型(腺瘤)(P <0.1)进行多变量Logistic回归分析,其中男性、息肉直径(≥10 mm)、息肉数目(≥3枚)为结直肠息肉EMR术后出血的独立危险因素(P <0.05)。结论:男性、息肉直径(≥10 mm)、息肉数目(≥3枚)为EMR息肉切除术后出血的独立危险因素,临床上应多加注意,以预防术后出血的发生。
Objective:Alimentary tract hemorrhage is the most frequent complication after colonoscopic polypectomy. The aim of this study was to identify the risk factors for postpolypectomy bleeding(PPB)after endoscopic mucosal resection(EMR). Methods:We retrospectively reviewed the clinical data of 111 patients who experienced PPB after EMR and 176 patients who did not. Results:Univariate logistic regression analysis showed that gender(male,P=0.008),numbers of polyps removed(≥3 polyps,P=0.001),polyp'diameter(≥10 mm,P < 0.001),location(right colon,P=0.036),use of antithrombotic drug(P=0.015)were significantly correlated with PPB. Above factors,hypertension(P < 0.1)and pathological type(adenoma,P < 0.1)were analyzed by multivariate logistic regression,and only gender(male),polyps' diameter(≥10 mm)and numbers of polyps removed(≥3 polyps)were significantly associated with PPB after EMR. Conclusion:Gender(male),polyps' diameter(≥10 mm)and polyp number(≥3 polyps)are significantly associated with PPB after EMR,and we should pay more attention to these factors for preventing PPB
Objective:Alimentary tract hemorrhage is the most frequent complication after colonoscopic polypectomy. The aim of this study was to identify the risk factors for postpolypectomy bleeding(PPB)after endoscopic mucosal resection(EMR). Methods:We retrospectively reviewed the clinical data of 111 patients who experienced PPB after EMR and 176 patients who did not. Results:Univariate logistic regression analysis showed that gender(male,P=0.008),numbers of polyps removed(≥3 polyps,P=0.001),polyp'diameter(≥10 mm,P < 0.001),location(right colon,P=0.036),use of antithrombotic drug(P=0.015)were significantly correlated with PPB. Above factors,hypertension(P < 0.1)and pathological type(adenoma,P < 0.1)were analyzed by multivariate logistic regression,and only gender(male),polyps' diameter(≥10 mm)and numbers of polyps removed(≥3 polyps)were significantly associated with PPB after EMR. Conclusion:Gender(male),polyps' diameter(≥10 mm)and polyp number(≥3 polyps)are significantly associated with PPB after EMR,and we should pay more attention to these factors for preventing PPB
引文
[1] Mouchli MA,Ouk L,Scheitel MR,et al. Colonoscopy sur-veillance for high risk polyps does not always prevent colorectal cancer[J]. World J Gastroenterol,2018,24(8):905-916
[2]黄招红,荣颜婷,刘灵丽,等.无症状体检人群结直肠息肉检出情况及相关因素分析[J].中国普通外科杂志,2017(10):1356-1359
[3]韩忠政,钟玲,肖尧生,等.无症状体检者2931例结直肠镜结果分析[J].山西医科大学学报,2017,48(10):1053-1056
[4] Mlynarsky L,Zelber-Sagi S,Miller E,et al. Endoscopic re-section of large colorectal adenomas-clinical experience of a tertiary referral centre[J]. Colorectal Dis,2018,20(5):391-398
[5] Kim JH,Lee HJ,Ahn JW,et al. Risk factors for delayed post-polypectomy hemorrhage:a case-control study[J]. J Gastroenterol Hepatol,2013,28(4):645-649
[6] Jaruvongvanich V,Prasitlumkum N,Assavapongpaiboon B,et al. Risk factors for delayed colonic post-polypecto-my bleeding:a systematic review and meta-analysis[J].Int J Colorectal Dis,2017,32(10):1399-1406
[7] Park SK,Seo JY,Lee MG,et al. Prospective analysis of delayed colorectal post-polypectomy bleeding[J]. Surg Endosc,2018,32(7):3282-3289
[8] Lin D,Soetikno RM,Mcquaid K,et al. Risk factors for postpolypectomy bleeding in patients receiving anticoagu-lation or antiplatelet medications[J]. Gastrointest En-dosc,2018,87(4):1106-1113
[9] Kwon MJ,Kim YS,Bae SI,et al. Risk factors for delayed post-polypectomy bleeding[J]. Intest Res,2015,13(2):160-165
[10] Wada Y,Kudo S,Tanaka S,et al. Predictive factors for complications in endoscopic resection of large colorectal lesions:a multicenter prospective study[J]. Surg Endosc,2015,29(5):1216-1222
[11] Toshiyuki,Kubo,Kentaro,et al. Heparin bridge therapy and post-polypectomy bleeding[J]. World J Gastroenterol,2016,22(45):10009-10014
[12] Cheung KS,Leung WK. Gastrointestinal bleeding in pa-tients on novel oral anticoagulants:Risk,prevention and management[J]. World J Gastroenterol,2017,23(11):1954-1963
[13] Niikura R,Yasunaga H,Yamada A,et al. Factors predic-ting adverse events associated with therapeutic colono-scopy for colorectal neoplasia:a retrospective nationwide study in Japan[J]. Gastrointest Endosc,2016,84(6):971-982
[14] PigòF,Bertani H,Manno M,et al. Colonic postpolypectomy bleeding is related to polyp size and heparin use[J]. Clin Endosc,2017,50(3):287-292
[15] Ferlitsch M,Moss A,Hassan C,et al. Colorectal polypec-tomy and endoscopic mucosal resection(EMR):European Society of Gastrointestinal Endoscopy(ESGE)clinical guideline[J]. Endoscopy,2017,49(3):270-297
[16] Rabeneck L,Paszat LF,Hilsden RJ,et al. Bleeding and perforation after outpatient colonoscopy and their risk fac-tors in usual clinical practice[J]. Gastroenterology,2008,135(6):1899-1906
[17] Shalman D,Gerson LB. Systematic review with meta-ana-lysis:the risk of gastrointestinal haemorrhage post-polyp-ectomy in patients receiving anti-platelet,anti-coagulant and/or thienopyridine medications[J]. Aliment Pharma-col Ther,2015,42(8):949-956
[18] Metz AJ,Bourke MJ,Moss A,et al. Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions[J]. Endoscopy,2011,43(6):506-511
[19] Ninomiya Y,Oka S,Tanaka S,et al. Risk of bleeding after endoscopic submucosal dissection for colorectal tumors in patients with continued use of low-dose aspirin[J]. J Gas-troenterol,2015,50(10):1041-1046
[20] Fujimoto K,Fujishiro M,Kato M,et al. Guidelines for gas-troenterological endoscopy in patients undergoing anti-thrombotic treatment[J]. Dig Endosc,2014,26(1):1-14
[21] Shibuya T,Nomura O,Kodani T,et al. Continuation of an-tithrombotic therapy may be associated with a high inci-dence of colonic post-polypectomy bleeding[J]. Dig En-dosc,2017,29(3):314-321
[22] Veitch AM,Vanbiervliet G,Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy,in-cluding direct oral anticoagulants:British Society of Gas-troenterology(BSG)and European Society of Gastrointesti-nal Endoscopy(ESGE)guidelines[J]. Gut,2016,65(3):374-389
[23] Choung BS,Kim SH,Ahn DS,et al. Incidence and risk factors of delayed postpolypectomy bleeding:a retrospec-tive cohort study[J]. J Clin Gastroenterol,2014,48(9):784-789
[24] Rutter MD,Nickerson C,Rees CJ,et al. Risk factors for adverse events related to polypectomy in the English Bow-el Cancer Screening Programme[J]. Endoscopy,2014,46(2):90-97
[2]黄招红,荣颜婷,刘灵丽,等.无症状体检人群结直肠息肉检出情况及相关因素分析[J].中国普通外科杂志,2017(10):1356-1359
[3]韩忠政,钟玲,肖尧生,等.无症状体检者2931例结直肠镜结果分析[J].山西医科大学学报,2017,48(10):1053-1056
[4] Mlynarsky L,Zelber-Sagi S,Miller E,et al. Endoscopic re-section of large colorectal adenomas-clinical experience of a tertiary referral centre[J]. Colorectal Dis,2018,20(5):391-398
[5] Kim JH,Lee HJ,Ahn JW,et al. Risk factors for delayed post-polypectomy hemorrhage:a case-control study[J]. J Gastroenterol Hepatol,2013,28(4):645-649
[6] Jaruvongvanich V,Prasitlumkum N,Assavapongpaiboon B,et al. Risk factors for delayed colonic post-polypecto-my bleeding:a systematic review and meta-analysis[J].Int J Colorectal Dis,2017,32(10):1399-1406
[7] Park SK,Seo JY,Lee MG,et al. Prospective analysis of delayed colorectal post-polypectomy bleeding[J]. Surg Endosc,2018,32(7):3282-3289
[8] Lin D,Soetikno RM,Mcquaid K,et al. Risk factors for postpolypectomy bleeding in patients receiving anticoagu-lation or antiplatelet medications[J]. Gastrointest En-dosc,2018,87(4):1106-1113
[9] Kwon MJ,Kim YS,Bae SI,et al. Risk factors for delayed post-polypectomy bleeding[J]. Intest Res,2015,13(2):160-165
[10] Wada Y,Kudo S,Tanaka S,et al. Predictive factors for complications in endoscopic resection of large colorectal lesions:a multicenter prospective study[J]. Surg Endosc,2015,29(5):1216-1222
[11] Toshiyuki,Kubo,Kentaro,et al. Heparin bridge therapy and post-polypectomy bleeding[J]. World J Gastroenterol,2016,22(45):10009-10014
[12] Cheung KS,Leung WK. Gastrointestinal bleeding in pa-tients on novel oral anticoagulants:Risk,prevention and management[J]. World J Gastroenterol,2017,23(11):1954-1963
[13] Niikura R,Yasunaga H,Yamada A,et al. Factors predic-ting adverse events associated with therapeutic colono-scopy for colorectal neoplasia:a retrospective nationwide study in Japan[J]. Gastrointest Endosc,2016,84(6):971-982
[14] PigòF,Bertani H,Manno M,et al. Colonic postpolypectomy bleeding is related to polyp size and heparin use[J]. Clin Endosc,2017,50(3):287-292
[15] Ferlitsch M,Moss A,Hassan C,et al. Colorectal polypec-tomy and endoscopic mucosal resection(EMR):European Society of Gastrointestinal Endoscopy(ESGE)clinical guideline[J]. Endoscopy,2017,49(3):270-297
[16] Rabeneck L,Paszat LF,Hilsden RJ,et al. Bleeding and perforation after outpatient colonoscopy and their risk fac-tors in usual clinical practice[J]. Gastroenterology,2008,135(6):1899-1906
[17] Shalman D,Gerson LB. Systematic review with meta-ana-lysis:the risk of gastrointestinal haemorrhage post-polyp-ectomy in patients receiving anti-platelet,anti-coagulant and/or thienopyridine medications[J]. Aliment Pharma-col Ther,2015,42(8):949-956
[18] Metz AJ,Bourke MJ,Moss A,et al. Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions[J]. Endoscopy,2011,43(6):506-511
[19] Ninomiya Y,Oka S,Tanaka S,et al. Risk of bleeding after endoscopic submucosal dissection for colorectal tumors in patients with continued use of low-dose aspirin[J]. J Gas-troenterol,2015,50(10):1041-1046
[20] Fujimoto K,Fujishiro M,Kato M,et al. Guidelines for gas-troenterological endoscopy in patients undergoing anti-thrombotic treatment[J]. Dig Endosc,2014,26(1):1-14
[21] Shibuya T,Nomura O,Kodani T,et al. Continuation of an-tithrombotic therapy may be associated with a high inci-dence of colonic post-polypectomy bleeding[J]. Dig En-dosc,2017,29(3):314-321
[22] Veitch AM,Vanbiervliet G,Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy,in-cluding direct oral anticoagulants:British Society of Gas-troenterology(BSG)and European Society of Gastrointesti-nal Endoscopy(ESGE)guidelines[J]. Gut,2016,65(3):374-389
[23] Choung BS,Kim SH,Ahn DS,et al. Incidence and risk factors of delayed postpolypectomy bleeding:a retrospec-tive cohort study[J]. J Clin Gastroenterol,2014,48(9):784-789
[24] Rutter MD,Nickerson C,Rees CJ,et al. Risk factors for adverse events related to polypectomy in the English Bow-el Cancer Screening Programme[J]. Endoscopy,2014,46(2):90-97