陈兰，文　峰，余卫中，夏伶俐，肖　丹



结直肠息肉内镜下电凝电切术后迟发性出血68例分析

陈兰，文峰，余卫中，夏伶俐，肖丹

目的探讨结直肠息肉电凝电切术后迟发性出血的临床特征及危险因素，为其防治提供参考。方法以电凝电切术后发生迟发性出血的结直肠息肉患者68例为观察组，同期经电凝电切治疗但未发生迟发性出血的结直肠息肉患者1986例为对照组，分析观察组临床特征、息肉特征、预后及迟发性出血的相关危险因素。结果出血发生在电凝电切术后2 h～28 d不等，其中大便中带血16例，便鲜血52例；一次便血量≤50 m l者26例，50～100 m l者18例，101～200m l者6例，＞200 m l者2例。68例中,单发息肉26例，多发42例；术后出血息肉最大直径≥10mm的48例，＜10mm的20例；有蒂息肉8例，亚蒂息肉13例，无蒂及平坦型息肉47例；术后病理类型：炎性增生性息肉16例，腺瘤52例。均经肠镜下成功止血。年龄≥60岁、合并高血压、冠心病、糖尿病、长期口服抗凝药、长期透析、多发息肉、息肉≥1 cm、无蒂息肉、腺瘤性息肉为结直肠息肉电凝电切术后迟发性出血的危险因素。结论结直肠息肉内镜下电凝电切治疗后迟发性出血患者以高龄及合并高血压者为主，可发生于术后2 h～4 w内，多为息肉较大的无蒂或扁平型息肉，病理类型多为腺瘤。内镜下止血是治疗迟发性出血的重要方法。

结直肠；息肉；电凝电切；迟发性出血；危险因素

[Abstract]Objective To explore the clinical characteristics and risk factors of patients with delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope in order to provide references for the prevention and treatment. Methods 68 patientswith delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope were chosen as observation group,and 1986 patients without delayed hemorrhage after the coagulation and electrotomy at the same time period were regarded as control group.Analysiswasmade in the clinical characteristics,polyps condition,prognosis,and correlated risk factors of delayed hemorrhage in the observation group.The risk factors of delayed hemorrhage were analyzed.Results Bleeding occurred 2 h to 28 d after the operation.There were 16 cases with bloody stool and 52 ones of stooling blood.There were 26 cases with the bleeding≤50 m l,18 ones with the bleeding of 50-100 m l,6 ones with the volume of 101-200 m l,and 2 more than 200 m l. Among the 68 cases,there were 26 cases of single polyp,42 ones ofmultiple polyps.After the operation,48 cases had themaximum diameter of the bleed polyps≥10 mm,and 20 patients had that＜10 mm.There were 8 patients with pedunculated polyps,13 ones with sub-pedunculated polyps,and 47 patientswith non-pedunculated or flat polyps.The postoperative pathological detection showed 16 patientswith inflammatory hyperplasia polyps and 52 oneswith adenoma.All the 68 patients obtained successful hemostasis under endoscope.The risk factors included age≥60,comp licated hypertension,coronary heart disease,diabetes,long-term oral administration with anticoagulants,long term dialysis,multiple polyps,polyp diameter≥1 cm,sessile polyps,and adenoma polyps. Conclusion Patients with delayed hemorrhage after electric coagulation and electrotomy for colorectal polyps under endoscope are mainly elderly peop le and the ones complicated with hypertension.The delayed hemorrhage may occur 2 h to 4 weeks after the operation.The polyps aremostly sessile or platypelloid type.The pathological types aremostly adenoma.Endoscopic hemostasis is an important treatmentmethod for delayed hemorrhage.

[Key words]colorectal;polyp;coagulation and electrotomy;delayed hemorrhage;risk factor

结直肠息肉是常见的消化系统良性病变，发病率高，但部分息肉如腺瘤性息肉可发生癌变，需及时切除。随着内镜技术的不断进展，内镜下电凝电切术是目前治疗结直肠息肉的主要方法，具有无创、安全、简便的优势[1]，临床应用广泛。……