儿童肠息肉切除术后迟发性出血的危险因素分析

Risk factors for delayed bleeding after intestinal polypectomy in children

摘要:

目的 分析儿童肠息肉切除术后迟发性出血的临床特征及相关危险因素，为临床手术干预提供理论依据。方法 回顾性收集郑州大学附属儿童医院内镜中心2014年1月—2021年12月收治的2 456例内镜下高频电凝圈套切除肠息肉患儿临床资料。依据术后是否发生迟发性出血，分为出血组（n=79）和非出血组（n=2 377）。采用多因素logistic回归分析探讨迟发性出血的危险因素。采用受试者操作特征曲线（receiver operating characteristic curve, ROC曲线）评估各项指标对迟发性出血的预测价值。结果 79例（3.22%）发生迟发性出血。5例发生严重迟发性出血行急诊肠镜止血，74例保守治疗，所有病例均止血成功。出血组和非出血组年龄、体重指数、便秘患儿比例、病变位置、内镜操作时间、切除方式的比较差异均有统计学意义（P<0.05）。直径6~10 mm和>20 mm的息肉切除后更易发生迟发性出血（P<0.05）。多因素logistic回归分析显示，内镜操作时间、息肉直径、切除方式与迟发性出血的发生显著相关（P<0.05）。ROC曲线分析显示，内镜操作时间、息肉直径、切除方式对肠息肉切除术后迟发性出血均有较好的预测价值，曲线下面积分别为0.706、0.688、0.627。结论 内镜下高频电凝圈套切除肠息肉术治疗肠息肉患儿迟发性出血发生率较低；内镜操作时间、息肉直径、切除方式与术后迟发性出血的发生密切相关。

Abstract:

Objective To investigate the clinical characteristics and risk factors of delayed bleeding after intestinal polypectomy in children, and to provide a theoretical basis for clinical surgical intervention of intestinal polyps.Methods A retrospective analysis was conducted on the clinical data of 2 456 children with intestinal polyps who underwent endoscopic high-frequency electrocoagulation loop resection in the Endoscopy Center of Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. According to the presence or absence of delayed bleeding after surgery, they were divided into bleeding group with 79 children and non-bleeding group with 2 377 children. A multivariate logistic regression analysis was used to investigate the risk factors for delayed bleeding. The receiver operating characteristic (ROC) curve was used to investigate the value of various indicators in predicting delayed bleeding.Results Of all 2 456 children, 79 (3.22%) experienced delayed bleeding, among whom 5 children with severe delayed bleeding underwent emergency colonoscopy for hemostasis and 74 received conservative treatment, and successful hemostasis was achieved for all children. There were significant differences between the bleeding and non-bleeding groups in age, body mass index, constipation rate, location of lesion, time of endoscopic procedure, resection method (P<0.05). Children with a diameter of polyps of 6-10 mm and >20 mm were more likely to develop delayed bleeding after resection (P<0.05). The multivariate logistic regression analysis showed that endoscopic operation time, polyp diameter, and resection method were significantly associated with delayed bleeding (P<0.05). The ROC curve analysis showed that the endoscopic operation time, polyp diameter, and resection method had a good value in predicting delayed bleeding after intestinal polypectomy, with an area under the ROC curve of 0.706, 0.688, and 0.627, respectively.Conclusions Endoscopic high-frequency electrocoagulation loop resection has a lower incidence of delayed bleeding in children with intestinal polyps, and the endoscopic operation time, polyp diameter, and resection method are closely associated with the occurrence of postoperative delayed bleeding.