结直肠肿物内镜下切除术后发生迟发性出血危险因素的Meta分析

目的探讨结直肠肿物内镜下切除术后发生迟发性出血的危险因素。 方法通过计算机检索2012年1月至2018年12月Pubmed、Cochrane、Embase、CNKI数据库、万方数据库中与结直肠肿物内镜下切除术后发生迟发性出血的危险因素相关文献，采用RevMan 5.3版软件进行统计处理，对纳入资料的异质性进行分析，计算OR值和95%可信区间。 结果共纳入文献17篇，总例数6 689例，其中364例发生了内镜下切除术后迟发性出血（ESD193例，EMR119例，EPMR52例），总发生率为5.45%。Meta分析结果显示：肿物位于近端结肠（OR：1.83，95%CI：1.31~2.56；P=0.0004）、抗血栓药物使用史（OR：1.61，95%CI：1.19~2.18；P=0.002）、组织学为高级别上皮内瘤变或早癌（OR：0.63，95%CI：0.45~0.89；P=0.009）、分块切除（OR：2.71，95%CI：1.32~3.51；P=0.002）、术中出血（OR：2.52，95%CI：1.56~4.10；P=0.0002）、未置入止血夹（OR：2.19，95%CI：1.20~3.99；P=0.01）、黏膜下重度纤维化（OR：3.67，95%CI：2.02~6.65；P<0.0001）为内镜下切除术后发生迟发性出血的危险因素。而年龄、性别、病灶大小、病灶形态、是否有合并症不是迟发性出血的危险因素。 结论结直肠肿物病灶位于近端结肠、抗血栓药物使用史、组织学为高级别上皮内瘤变或早癌、分块切除、术中出血、未置入止血夹、黏膜下重度纤维化为内镜下切除术后发生迟发性出血的主要危险因素。

Meta-analysis of the risk factors for delayed bleeding after endoscopic resection of colorectal tumors

ObjectiveTo investigate the risk factors for delayed bleeding after endoscopic resection of colorectal tumors. MethodsThe literature on the risk factors of delayed bleeding after endoscopic resection of colorectal tumors was retrieved combined with manual retrieval from Pubmed, Cochrane, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang Database published January 2012 to December 2018. Pooled odds ratio (OR) and 95% confidence intervals (95%CI) were calculated and the heterogeneity was also assessed. ResultsA total of 17 published studies were included, with total of 6 689 cases, of which 364 cases developed delayed bleeding after endoscopic resection (ESD 193 cases, EMR 119 cases, EPMR 52 cases), Meta analysis showed that the tumor located in the proximal colon (OR: 1.83, 95% CI: 1.31~2.56; P=0.0004), history of antithrombotic drugs (OR: 1.61, 95%CI: 1.19~2.18; P=0.002), high grade intraepithelial neoplasia or early cancer (OR: 0.63, 95%CI: 0.45~0.89; P=0.009), resection method (OR: 2.71, 95% CI: 1.32~3.51; P=0.002), bleeding during operation (OR: 2.52, 95% CI: 1.56~4.10; P=0.0002), no clip placement (OR: 2.19, 95% CI: 1.20~3.99; P=0.01), and severe submucosal fibrosis (OR: 3.67, 95% CI: 2.02~6.65; P<0.0001) were the risk factors for delayed bleeding after endoscopic resection. Moreover, age, sex, lesion size, morphology, comorbidity were not associated with delayed bleeding. ConclusionColorectal tumor located in the proximal colon, history of anti-thrombotic drug, high grade intraepithelial neoplasia or early cancer, piecemeal resection, intraoperative hemorrhage, no clip placement, severe submucosal fibrosis were the risk factors for delayed bleeding after endoscopic resection.