慢性肝病患者息肉切除术后延迟出血的发生率及危险因素
Incidence and risk factors of delayed postpolypectomy bleeding in patients with chronic liver disease.
作者信息
Lee Hee Seung, Park Jae Jun, Kim Seung Up, Lee Jeung Eun, Leem Ga Lam, Kim Yonsoo, Kim Beom Kyung, Park Jun Yong, Kim Do Young, Ahn Sang Hoon, Han Kwang-Hyub
机构信息
a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;
b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;
出版信息
Scand J Gastroenterol. 2016;51(5):618-24. doi: 10.3109/00365521.2015.1121513. Epub 2015 Dec 14.
OBJECTIVE
Hepatologists and colonoscopists often hesitate to perform a colonoscopic polypectomy in patients with chronic liver disease (CLD), especially those with cirrhosis, because of the risk of postpolypectomy bleeding (PPB). We aimed to investigate the incidence and risk factors of delayed PPB after a colonoscopic polypectomy in patients with CLD.
MATERIALS AND METHODS
In total, 152 patients with CLD who underwent colonoscopic polypectomy from December 2005 to December 2012 were retrospectively reviewed.
RESULTS
Cirrhosis was identified in 80 (52.6%) patients. During the study period, 442 polyps were removed and delayed PPB developed in 14 (9.2%) patients. The incidence of delayed PPB was significantly higher in patients with cirrhosis than in those without the disease (13.8% [n = 11] vs. 4.2% [n = 3], p = 0.041). The polyp size (odds ratio, 1.087; 95% confidence interval, 1.009-1.172) and cirrhosis (odds ratio, 8.535; 95% confidence interval, 2.417-30.140) were independent risk factors for delayed PPB. In patients with cirrhosis, the optimal cut-off size to identify high-risk polyps for delayed PPB was 10 mm (area under the receiver operating characteristics curve, 0.737; sensitivity, 52%; specificity, 88%).
CONCLUSION
Caution is needed when colonoscopic polypectomy is planned in patients with CLD who have larger polyps and cirrhosis.
目的
由于息肉切除术后出血（PPB）的风险，肝病学家和结肠镜检查医师在慢性肝病（CLD）患者，尤其是肝硬化患者中进行结肠镜息肉切除术时常常犹豫不决。我们旨在调查CLD患者结肠镜息肉切除术后延迟性PPB的发生率及危险因素。
材料与方法
回顾性分析2005年12月至2012年12月期间接受结肠镜息肉切除术的152例CLD患者。
结果
80例（52.6%）患者被诊断为肝硬化。在研究期间，共切除442枚息肉，14例（9.2%）患者发生延迟性PPB。肝硬化患者延迟性PPB的发生率显著高于无肝硬化患者（13.8% [n = 11] 对4.2% [n = 3]，p = 0.041）。息肉大小（比值比，1.087；95%置信区间，1.009 - 1.172）和肝硬化（比值比，8.535；95%置信区间，2.417 - 30.140）是延迟性PPB的独立危险因素。在肝硬化患者中，识别延迟性PPB高危息肉的最佳截断大小为10 mm（受试者工作特征曲线下面积，0.737；敏感度，52%；特异度，88%）。
结论
对于有较大息肉且合并肝硬化的CLD患者，计划进行结肠镜息肉切除术时需谨慎。
Zotero 插件