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内镜黏膜切除术联合氩等离子体凝固术治疗结肠息肉的疗效观察和术后延迟性出血的危险因素分析

Clinical observation of EMR combined with APC in the treatment of colonic polyps and analysis of risk factors for delayed bleeding after operation

发布日期:2023-07-19 11:57:12 阅读次数: 0 下载

 

作者:吉茜茜,田尧,马林

 

单位:海安市人民医院 消化内科, 江苏 海安 226600

 

Authors: Ji QianqianTian YaoMa Lin

 

Unit: Department of GastroenterologyHai 'an City People's HospitalHai 'an 226600 JiangsuChina

 

摘要:

目的 探讨内镜黏膜切除术(EMR)联合氩等离子体凝固术(APC)治疗结肠息肉的临床疗效,分析迟发性出血(PPB)的危险因素,为提高临床诊治提供参考依据。方法 选择2019年1月至2021年12月海安市人民医院行内镜治疗的结肠息肉患者,根据随机数字表法分成观察组和对照组,每组各85例。观察组采用EMR联合APC治疗,对照组采用EMR治疗,观察术中相关指标和术后康复指标。根据术后是否发生延迟性出血(PPB)分成PPB组(n=11)和无PPB组(n=159),采用Logistic回归模型分析发生术后PPB的危险因素。结果 观察组的手术时间、术中出血量和术中出血发生率低于对照组,差异有统计学意义(P<0.05);观察组的一次性完整切除率高于对照组,术中肠穿孔发生率低于对照组,差异无统计学意义(P>0.05)。观察组术后住院天数和PPB发生率低于对照组,差异有统计学意义(P<0.05);观察组的术后疼痛指数和复发率低于对照组,总有效率高于对照组,差异无统计学意义(P>0.05)。单因素分析显示,结肠息肉EMR术后发生PPB与抗血栓治疗史、息肉直径、息肉形态、手术方式和术后进食时间有关(均P<0.05);多因素分析显示,抗血栓治疗史、息肉直径>1.5 cm、息肉无蒂、手术方式和术后48 h内进食是结肠息肉患者EMR术后发生PPB的独立危险因素(均P<0.05)。结论 EMR联合APC治疗能提高结肠息肉的手术效率、降低并发症发生率,促进术后康复,改善疾病预后。抗血栓治疗史、息肉直径>1.5 cm、息肉无蒂、手术方式和术后48 h内进食是结肠息肉术后发生PPB的独立危险因素。 

 

关键词:内镜黏膜切除术; 氩等离子体凝固术; 结肠息肉; 疗效; 迟发性出血; 危险因素

 

Abstract

Objective To investigate the clinical efficacy of endoscopic mucosal resection (EMR) combined with argon plasma coagulation (APC) in the treatment of colonic polypsand to analyze the risk factors of delayed hemorrhage(PPB) so as to provide a reference for improving the clinical diagnosis and treatment. Method Patients with colonic polyps who underwent endoscopic treatment in Hai’an Hospital Affiliated to Nantong University from January 2019 to December 2021 were selected and divided into observation group and control group according to random number representationwith 85 cases in each group. The observation group was treated with EMR combined with APCwhile the control group was treated with EMR. The related indexes during operation and postoperative rehabilitation indexes were observed. The patients were divided into PPB group (n=11) and non-PPB group (n=159) according to the occurrence of delayed bleeding (PPB) after operation. Logistic regression model was used to analyze the risk factors of PPB. Result The operation timeintraoperative blood loss and incidence of IPB in the observation group were lower than those in the control groupand the differences were statistically significant (P<0.05). The one-time complete resection rate of the observation group was higher than that of the control groupand the incidence of intestinal perforation during operation was lower than that of the control groupand the differences were not statistically significant (P>0.05). The postoperative hospitalization days and incidence of PPB in the observation group were lower than those in the control groupand the differences were statistically significant (P<0.05). The postoperative VAS and recurrence rate of the observation group were lower than those of the control groupand the total effective rate was higher than that of the control group and the differences were not statistically significant (P >0.05). Univariate analysis showed that the occurrence of PPB after EMR was related to the history of antithrombotic treatmentpolyp diameterpolyp shapesurgical method and postoperative feeding time(all P<0.05). Multivariate analysis showed that history of antithrombotic therapypolyp diameter >1.5 cmsessile polypsoperation method and feeding within 48 hours after surgery were independent risk factors for PPB in patients with colonic polyps after EMR (all P<0.05). Conclusion EMR combined with APC can improve the surgical efficiency of colonic polypsreduce the incidence of complicationspromote postoperative rehabilitation and improve the prognosis of the disease. History of antithrombotic therapypolyp diameter >1.5 cmsessile polypoperation method and feeding within 48 hours after operation are independent risk factors for PPB after colonic polyp surgery.

 

Key Words:  Endoscopic mucosal resection; Argon plasma coagulation; Colonic polyps; Curative effect; Delayed bleeding; Risk factors

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