1例直肠侧向发育型肿瘤内镜黏膜下剥离术后反复迟发性出血处理

Management of Recurrent Delayed Bleeding after Endoscopic Submucosal Dissection for a Rectal Laterally Spreading Tumor

摘要: 目的：分析侧向发育型肿瘤内镜黏膜下剥离术(ESD)后反复迟发性出血的相关处理。侧向发育肿瘤(LST)是指直径 ≥ 10 mm，沿肠壁侧向扩展而非垂直生长的一类表浅性结直肠病变。内镜黏膜下剥离术(ESD)作为内镜下治疗消化道病变的微创手术，近年来已经日趋成熟，多项国际指南及共识意见已将ESD作为侧向发育型病变的首选手术方式。方法：我院2023年10月份一例直肠侧向发育型肿瘤ESD术后四次出血，多次复查肠镜、血常规、凝血常规，多次输血，予以“奥曲肽”、“白眉蛇毒血凝酶”、“酚磺乙胺”止血、补液等治疗，分析年龄、ESD病灶位置、糖尿病血糖控制水平及血凝酶的使用对ESD术后反复迟发性出血的影响及机制。本例老年直肠侧向发育型肿瘤ESD术后反复迟发性出血的成功处理，为我们以后在ESD术后迟发性出血的处理中提供了宝贵经验。

Abstract: Objective: To analyze the management of recurrent delayed bleeding following endoscopic submucosal dissection (ESD) for laterally spreading tumors (LSTs). LSTs refer to superficial colorectal lesions ≥ 10 mm in diameter that extend laterally along the intestinal wall rather than vertically. ESD, a minimally invasive endoscopic technique for treating gastrointestinal lesions, has become increasingly refined in recent years, with multiple international guidelines and consensus statements now recommending it as the primary treatment for LSTs. Methods: We report a case of recurrent delayed bleeding (four episodes) after ESD for a rectal LST in October 2023. The patient underwent repeated colonoscopies, complete blood counts, and coagulation tests, along with multiple blood transfusions. Hemostatic agents (including octreotide, hemocoagulase agkistrodon, and etamsylate) and fluid resuscitation were administered. We evaluated the impact and potential mechanisms of age, ESD lesion location, diabetes mellitus (glycemic control status), and hemocoagulase use on recurrent delayed post-ESD bleeding. The successful management of this case provides valuable insights for handling delayed bleeding after ESD in clinical practice.