肠息肉切除术后出血再次结肠镜检查的临床特征

Clinical Features of Re-Colonoscopy after Bleeding after Intestinal Polypectomy

摘要: 目的：探讨结直肠息肉切除术后出血(Post-polypectomy Bleeding, PPB)患者再次结肠镜检查的内镜下表现并初步评估再次结肠镜检查的时机。方法：回顾性分析我院2010~2020年行结肠镜下息肉切除术后出血并再次结肠镜检查的患者的临床特征，并根据再次结肠镜下是否发现活动性出血将其分为活动性出血组和无活动性出血组，分别对两组患者的首次内镜下特征、再次内镜检查的表现及相关实验室检查指标进行比较和分析。结果：内镜结直肠PPB发生时间为4.6 ± 3.5天(中位3.0天；范围1.0~13.0天)，息肉的平均直径为13.23 ± 7.95 mm。48例患者中结肠镜下存在活动性出血31例次，息肉位置(P值 = 0.763)、息肉大小(P值 = 0.498)与内镜下是否发现活动性出血无相关性，Hb下降超过15.5 g/L与内镜下存在活动性出血相关(OR 11.143; 95％CI 2.743~45.262, P = 0.001)。31例PPB患者均内镜止血成功，采用单独金属夹、金属夹联合肾上腺素黏膜下注射、金属夹联合电凝、金属夹联合尼龙绳、金属夹联合组织胶进行止血治疗的比例分别为64.52%、12.90%、9.68%、9.68%、3.23%。结论：结肠息肉切除术后出血多发生于术后3天，Hb下降超过15.5 g/L可能是再次结肠镜检查的有效指标，内镜下止血有较高的成功率。

Abstract: Object: To explore the endoscopic manifestations of post-polypect-omy bleeding (PPB) patients with re-colonoscopy and to initially evaluate the timing of re-colonoscopy. Method: To retrospectively analyze the clinical characteristics of patients who underwent colonoscopic polypectomy bleeding and re-colonoscopy in our hospital from 2010 to 2020, and divide them into active ble-eding group and no-bleeding group according to whether active bleeding was found under re-colonoscopy, further compare and analyze the two groups of the characteristics of the first endoscopy, the performance of the re-endoscopy and related laboratory examination indicators. Results: The occurrence time of colorectal PPB was 4.6 ± 3.5 days (median 3.0 days; range 1.0~13.0 days), and the average diameter of polyps was 13.23 ± 7.95 mm. There were 31 cases of active bleeding under re-colonoscopy in 48 patients. The position of polyp (P value = 0.763), polyp size (P value = 0.498) were no significantly different between the active bleeding group and no-bleeding group. The optimal cut-off value for Hb was determined using ROC analysis and was 15.5 g/L. Multivariate analysis showed that Hb drop > 15.5 g/L (11.143; 95%CI 2.743~45.262, P = 0.001) was significantly associated with active bleeding under re-endoscopy after PPB. All 31 patients were successfully endoscopic hemostasis. The percentages of hemostasis treatment with single metal clip, metal clip combined with submucosal injection of adrenaline, metal clip combined with electrocoagulation, metal clip combined with nylon cord, and metal clip combined with tissue glue were 64.52%, 12.90%, 9.68%, 9.68%, 3.23%, respectively. Conclusion: Colorectal PPB usually occurs 3 days after surgery. A drop in Hb of more than 15.5 g/L may be an effective indicator for re-colonoscopy. Endoscopic hemostasis has a higher success rate.