摘要
目的 分析金属钛夹夹闭方式对结直肠息肉内镜黏膜切除术(EMR)后迟发性出血的影响以及相关影响因素.方法 回顾性选取2020年3月至2022年6月安徽医科大学第一附属医院收治的60例行结直肠息肉切除术患者作为研究对象,根据金属钛夹夹闭方式不同将患者分为直立位组(n=31)和平行位组(n=29);根据患者术后有无迟发性出血分为出血组(n=10)和未出血组(n=50).比较直立位组与平行位组患者的围手术期一般资料(手术时间、肠鸣音恢复时间、术中出血量、疼痛评分)、治疗成功率与并发症发生情况.比较出血组和未出血组患者一般临床资料(年龄、性别、合并高血压、合并高血脂、合并糖尿病、息肉数量、息肉形态、息肉分布和切除数量及大小、金属钛夹夹闭方式).采用Logistic多因素回归分析结直肠息肉患者发生迟发性出血的影响因素.结果 两组患者手术时间、肠鸣音恢复时间、视觉模拟评分法(VAS)评分比较,差异均无统计学意义(P＞0.05);直立位组患者术中出血量为(49.69± 6.57)mL,低于平行位组[(58.41±6.85)mL],差异有统计学意义(P＜0.05).两组患者治疗成功率、肠穿孔、腹痛发生率比较,差异均无统计学意义(P＞0.05);直立位组患者迟发性出血率为6.45％,明显低于平行位组(27.59％),差异有统计学意义(P＜0.05).出血组患者合并高血压、合并高血脂、有蒂息肉、多肠段分布、平行位的患者比例分别为70.00％、60.00％、50.00％、50.00％、80.00％,均高于未出血组(34.00％、26.00％、12.00％、12.00％、42.00％),出血组患者切除数量、最大基底直径、平均基底直径分别为(1.92±0.85)枚、(0.97±0.36)cm、(0.82±0.32)cm,均高于未出血组[(1.32±0.76)枚、(0.69±0.30)cm、(0.68±0.28)cm],差异均有统计学意义(P＜0.05).Logistic 多因素回归分析结果显示,术中出血量、合并高血压、合并高血脂、切除数量、最大基底直径是结直肠息肉患者发生迟发性出血的危险因素(P＜0.05),直立位金属钛夹夹闭方式是结直肠息肉患者发生迟发性出血的保护因素(P＜0.05).结论 与平行位金属钛夹夹闭方式相比,直立位金属钛夹夹闭方式用于结直肠息肉EMR术中出血量更少,迟发性出血发生率更低.术中出血量、合并高血压、合并高血脂、切除数量、最大基底直径是结直肠息肉患者发生迟发性出血的危险因素,直立位金属钛夹夹闭方式是结直肠息肉患者发生迟发性出血的保护因素.
Abstract
Objective To analyze the effect of upright titanium clip on delayed bleeding after endoscopic mucosal resection(EMR).Methods Sixty patients who underwent rectal polypectomy at the First Affiliated Hospital of Anhui Medical University from March 2020 to June 2022 were retrospectively selected as the study subjects.Patients were divided into the upright position group(n=31)and the parallel position group(n=29)according to different clamping methods of metal titanium clips.According to whether the patient has delayed bleeding after sur-gery,they were divided into the bleeding group(n=10)and the non bleeding group(n=50).The perioperative general information(opera-tion time,bowel sound recovery time,intraoperative bleeding volume,pain score),treatment success rate,and incidence of complications were compared between the upright position group and the parallel position group.The general clinical data(age,gender,hypertension,hyperlipi-demia,diabetes,number of polyps,polyp morphology,polyp distribution,number and size of polyps removed,and metal titanium clips)of pa-tients in the bleeding group and the non bleeding group were compared.The influencing factors of delayed bleeding in patients with colorectal pol-yps were analyzed using Logistic multiple regression analysis.Results There was no statistically significant difference in operation time,bowel sound recovery time,and visual analogue scale(VAS)score between the two groups of patients(P＞0.05);the intraoperative bleeding volume of the upright position group was(49.69±6.57)mL,which was lower than that of the parallel position group[(58.41±6.85)mL],and the difference was statistically significant(P＜0.05).The rates of patients with hypertension,hyperlipidemia,pedunculated polyps,multi segment distribution,and parallel position in the bleeding group were 70.00％,60.00％,50.00％,50.00％,and 80.00％,respectively,which were higher than those in the non bleeding group(34.00％,26.00％,12.00％,12.00％,and 42.00％),the number of resections,maximum basal diameter,average basal diameter in the bleeding group were(1.92±0.85)pieces,(0.97±0.36)cm,and(0.82±0.32)cm,respectively,which were higher than those in the non bleeding group[(1.32±0.76)pieces,(0.69±0.30)cm,(0.68±0.28)cm)],the differences were statistically significant(P＜0.05).The results of Logistic multiple regression analysis showed that intraoperative bleeding volume,concomitant hypertension,concomitant hyperlipidemia,number of resections,and maximum basal diameter were risk factors for delayed bleeding in patients with colorectal polyps(P＜0.05),while upright metal titanium clip clamping method was a protective factor for delayed bleeding in patients with colorectal polyps(P＜0.05).Conclusion Compared with the parallel position metal titanium clip clamping method,the upright position metal titanium clip clamping method is used for EMR patients with colorectal polypectomy with less intraoperative bleeding and lower incidence of delayed bleeding.Intraoperative bleeding,hypertension,hyperlipidemia,the number of resections,and the maximum basal diameter are the risk factors for delayed bleeding in patients with colorectal polyps.The clamping method of metal titanium clips in upright position is the protective factor for de-layed bleeding in patients with colorectal polyps.
基金项目
安徽省高等学校自然科学研究项目(KJ2020A0190)
维普
万方数据