儿童结肠息肉内镜治疗术后并发症的相关因素研究

目的　探讨儿童结肠息肉内镜治疗术后并发症的临床特点及相关因素。方法　回顾性分析2014年1月至2016年12月在西安交通大学附属儿童医院379例行电子结肠镜下息肉切除术患儿的临床资料。结果　在379例患儿中，发生相关并发症共计36例（9.1%），包括发热6例（1.6%），出血30例（7.9%），无一例发生肠穿孔。在30例出血患儿中26例（6.9%）为少量出血，4例（1.1%）为大出血，后经急诊内镜成功止血，无一例追加外科手术。单因素相关分析结果表明，患者术前便血持续时间、息肉位置、是否有蒂、切除方式和术后制动与术后并发症显著相关（P＜0.05）。多因素Logistic回归分析结果表明，患者术前便血时间越久，发生术后并发症的风险越高，OR值为1.08［95%CI为（1.03，2.14），P＝0.003］；非直肠部位息肉（包括横结肠、升结肠和回盲部）的患者发生术后并发症的风险是直肠息肉患者的18.88倍［95%CI为（2.23，159.74），P＝0.007］；有蒂患者发生术后并发症的风险是无蒂患者的11.424倍［95%CI为（2.42，53.91），P＝0.002］。结论　儿童结肠息肉内镜下切除是安全有效的，术后出血是最常见的并发症。术前便血时间越长、息肉的位置离肛门越远、有蒂的息肉术后并发症的风险越大。金属钛夹的使用、术后严格的制动、软化大便可减少并发症的发生。

Study on related factors of postoperative complications after endoscopic treatment for colon polyps in children

Objective　To investigate the clinical characteristics and related factors of postoperative complications in children with colon polyps treated by endoscopy. Methods　Clinical data of 379 hospitalized children who underwent electronic colonoscopic polypectomy in Children's Hospital Affiliated to Xi’an Jiaotong University from January 2014 to December 2016 were collected and retrospectively analyzed. Results　Among 379 patients with polypectomy，36 patients（9.1%） had related complications，including fever in 6 patients（1.6%） and bleeding in 30 patients（7.9%）；there was no intestinal perforation. Among the 30 cases of bleeding，26 cases（6.9%） were with minor bleeding，and 4 cases（1.1%） were with massive bleeding. The bleeding was successfully stopped by emergency endoscopy，and no additional surgery was performed. Univariate correlation analysis found that the duration of hematochezia，the location of the polyp，being with pedicle or not，the method of resection and postoperative braking were significantly correlated with postoperative complications（P＜0.05）. Multi-factor Logistic regression analysis found that： the longer the time of hematochezia，the higher the risk of postoperative complications，OR value being 1.08 ［95%CI：（1.03，2.14），P＝0.003］. Patients with non-rectal polyps（including transverse colon，ascending colon and ileocecal） were 18.88 times more likely to have postoperative complications than patients with rectal polyps ［95%CI：（2.23，159.74），P＝0.007］. The risk of postoperative complications in patients with pedicle was 11.424 times higher than that in patients without pedicle［95%CI：（2.42，53.91），P＝0.002］. Conclusion　Endoscopic resection of colon polyps in children is safe and effective，and postoperative bleeding is the most common complication. The longer period of hematochezia，the polyp being farther away from the anus，and being with pedicle increases the risk of postoperative complications. The use of titanium clips，strict postoperative braking and softening stool can reduce the occurrence of complications.