内镜下治疗大肠息肉并发出血的危险因素以及腺瘤性息肉的癌变特征分析

目的该研究目的是认识直径≥1.0 cm大肠息肉临床特点、内镜下治疗出血的危险因素及腺瘤性息肉癌变的特征分析。方法回顾该院2014年1月1日-2016年1月1日经内镜下切除的直径≥1.0 cm大肠息肉741例患者,共884枚息肉;分析患者的临床资料、内镜下特点、息肉切除出血危险因素及腺瘤性息肉癌变的特征。结果大肠息肉内镜下切除术术中、迟发性出血的单因素分析中,发现性别(P=0.017)、息肉部位(P=0.011)、息肉大小(P=0.004)、表面是否分叶(P=0.010)、内镜手术方式(P=0.029)在两组间差异有统计学意义;以息肉为观察单位,对患者临床资料和内镜下特点进行Logistic回归多因素分析时,发现性别(P=0.012,OR=2.671,95%CI=1.246~5.728)为独立危险因素,男性比女性更易发生出血;息肉部位为乙状结肠相对于直肠来讲为保护因素(P=0.011,OR=0.348,95%CI=0.154~0.786),息肉大小≥3.0 cm相对于息肉大小为1.0~1.9 cm来讲为危险因素(P=0.049,OR=2.530,95%CI=1.005~6.374)。大肠腺瘤性息肉癌变特征单因素分析时,发现表面是否分叶(P=0.001)、是否光滑(P=0.017)、山田分型(P=0.008)在两组间差异有统计学意义,进行Logistic回归分析多因素时,得出表面分叶(P=0.001,OR=6.556,95%CI=2.326~18.475)是腺瘤性息肉癌变的独立危险因素。结论内镜下治疗大肠息肉是一种安全的治疗方法 ;以息肉为观察单位,性别为大肠息肉内镜下切除术术中、迟发性出血的独立危险因素,男性比女性更易发生出血;息肉直径越大,发生出血的可能性越大;表面分叶的大肠腺瘤性息肉提示癌变的可能性大。

Analysis of risk factors for bleeding following endoscopic treatment of colorectal polyps and feature analysis for carcinogenesis of adenomatous polyps

To investigate the clinical data, risk factors for bleeding following endoscopic treatment of colorectal polyps (diameter ≥ 1.0 cm) and feature analysis for carcinogenesis of adenomatous polyps. Method It was analyzed retrospectively that the clinical data, endoscopic characteristics, risk factors for bleeding and features for carcinogenesis of adenomatous polyps in 741 patients with a total of 884 colorectal polyps (diameter ≥ 1.0 cm) of our hospital from January 1, 2014 to January 1, 2016, which were resected under endoscope. Result Univariate analysis of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, we found that gender (P = 0.017), location (P = 0.011), size (P = 0.004), lobulated or not (P = 0.010), resection methods under endoscope (P = 0.029) were statistically significant deviation between the two groups; taking the polyp as observation unit, multivariate Logistic regression analysis of their clinical data and endoscopic characteristics, we found gender (P = 0.012, OR = 2.671, 95% CI = 1.246 ~ 5.728) was an independent risk factor, men are more prone to bleeding than women; it was a protective factor for the location of polyps is sigmoid colon compared to rectum (P = 0.011, OR = 0.348, 95% CI = 0.154 ~ 0.786), and it was a risk factor for the polyps whose diameters ≥ 3.0 cm compared to among 1.0 ~ 1.9 cm. Univariate analysis of the features for carcinogenesis of colorectal adenomatous polyps, we found that surface lobulated or not (P = 0.001), surface smooth or not (P = 0.017), Yamada classification (P = 0.008) were statistically significant deviation, and the logistic regression analysis identified surface lobulation (P = 0.001, OR = 6.556, 95% CI = 2.326 ~ 18.475) was an independent risk factor for carcinogenesis of adenomatous polyps. Conclusion Resection of colorectal polyps under endoscope is a safe treatment method. Taking the polyp as observation unit, gender is an independent risk factor of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, men are more prone to bleeding than women; the larger the diameters of polyps are, the higher the bleeding rates could be. Surface lobulation of colorectal adenomatous polyps are more likely lead to carcinogenesis.