Bae Gyu Hwan, Jung Jin Tae, Kwon Joong Gu, Kim Eun Young, Park Jin Hong, Seo Jung Hyun, Kim Jong Yeon
Division of Gastroenterology, Department of Internal Medicine, Catholic University, Daegu College of Medicine, 33, Dooryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea.
Korean J Gastroenterol. 2012 Jun 25;59(6):423-7. doi: 10.4166/kjg.2012.59.6.423.
BACKGROUND/AIMS: Colonoscopic polypectomy is a valuable procedure for preventing colorectal cancer, but is not without complications. Delayed bleeding after colonoscopic polypectomy is a rare, but serious complication. The aim of this study was to identify risk factors of delayed bleeding after colonoscopic polypectomy.
A retrospective case-control study was conducted in a single university hospital. Forty cases and 120 controls were included. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, endoscopist's experience, resection method, use of sedation, and use of prophylactic hemostasis.
In univariate analysis, size, histology and number of resected polyps, endoscopist's experience, resection method and use of prophylactic hemostasis were significant risk factors for delayed bleeding after colonoscopic polypectomy. In multivariate analysis, risk of delayed bleeding increased by 11.6% for every 1 mm increase in resected polyp diameter (OR, 1.116; 95% CI 1.041-1.198; p=0.002). Number of resected polyps (OR, 1.364; 95% CI, 1.113-1.671; p=0.003) and endoscopist's experience (OR, 6.301; 95% CI, 2.022-19.637; p=0.002) were significant risk factors for delayed bleeding after colonoscopic polypectomy.
Size and numbers of resected polyps, and endoscopist's experience were independent risk factors for delayed bleeding after colonoscopic polypectomy. More caution would be necessary when removing polyps with these factors.
背景/目的：结肠镜息肉切除术是预防结直肠癌的一项重要手术，但并非没有并发症。结肠镜息肉切除术后延迟出血是一种罕见但严重的并发症。本研究的目的是确定结肠镜息肉切除术后延迟出血的危险因素。
在一家大学医院进行了一项回顾性病例对照研究。纳入40例病例和120例对照。收集的数据包括合并症、抗血小板药物的使用、切除息肉的大小和数量、切除息肉的组织学和大体形态、内镜医师的经验、切除方法、镇静剂的使用以及预防性止血的使用。
单因素分析中，切除息肉的大小、组织学和数量、内镜医师的经验、切除方法和预防性止血的使用是结肠镜息肉切除术后延迟出血的显著危险因素。多因素分析中，切除息肉直径每增加1mm，延迟出血风险增加11.6%（比值比，1.116；95%可信区间1.041-1.198；p=0.002）。切除息肉的数量（比值比，1.364；95%可信区间，1.113-1.671；p=0.003）和内镜医师的经验（比值比，6.301；95%可信区间，2.022-19.637；p=0.002）是结肠镜息肉切除术后延迟出血的显著危险因素。
切除息肉的大小和数量以及内镜医师的经验是结肠镜息肉切除术后延迟出血的独立危险因素。存在这些因素时切除息肉需要更加谨慎。
