Sato Yoshinori, Yasuda Hiroshi, Nakamoto Yusuke, Kiyokawa Hirofumi, Yamashita Masaki, Matsuo Yasumasa, Maehata Tadateru, Yamamoto Hiroyuki, Mimura Hidefumi, Itoh Fumio
Division of Gastroenterology and Hepatology, Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan.
Department of Radiology St. Marianna University School of Medicine Kawasaki Japan.
JGH Open. 2021 Jan 27;5(3):343-349. doi: 10.1002/jgh3.12499. eCollection 2021 Mar.
Colonic diverticular bleeding (CDB) stops spontaneously, but sometimes, excessive bleeding does not allow hemostasis and requires interventional radiology (IR)/surgery. We examined risk factors in patients who required IR/surgery for CDB and late recurrent bleeding rate after IR/surgery.
This retrospective case-control study was conducted at a tertiary center. We included 608 patients who required hospitalization for CDB. Patients were investigated for risk factors using logistic regression analysis. We also investigated early and late recurrent bleeding rates following IR/surgery.
In 261 patients (42.9%), the bleeding source was identified, and endoscopic hemostasis was performed; 23 (3.8%) required IR/surgery. In multivariate analysis, shock state with a blood pressure of ≤90 mmHg ( < 0.001; odds ratio [OR], 20.1; 95% confidence interval [CI], 5.08-79.5), positive extravasation on contrast-enhanced computed tomography ( < 0.001; OR 9.5, 95% CI 2.85-31.4), two or more early recurrent bleeding episodes ( = 0.002; OR 7.4, 95% CI 2.14-25.4), and right colon as the source of bleeding ( = 0.023; OR 4.1, 95% CI 1.25-14.0) were independent risk factors requiring IR/surgery. Early recurrent bleeding was observed in 0% and 28.0% patients ( < 0.001) in the IR/surgery and no IR/surgery groups, respectively, whereas late recurrent bleeding rate was observed in 43.4% and 30.7% patients ( = 0.203) in the IR/surgery and no IR/surgery groups, respectively. Four patients who required surgery experienced late recurrent bleeding at a site different from the initial CDB.
Although IR/surgery is an effective hemostatic treatment wherein endoscopic treatment is unsuccessful, late recurrent bleeding cannot be prevented.
结肠憩室出血（CDB）通常会自行停止，但有时出血过多无法止血，需要介入放射学（IR）/手术治疗。我们研究了因CDB需要IR/手术治疗的患者的危险因素以及IR/手术治疗后的晚期再出血率。
这项回顾性病例对照研究在一家三级中心进行。我们纳入了608例因CDB需要住院治疗的患者。采用逻辑回归分析对患者的危险因素进行调查。我们还调查了IR/手术治疗后的早期和晚期再出血率。
在261例患者（42.9%）中确定了出血源，并进行了内镜止血；23例（3.8%）需要IR/手术治疗。多因素分析显示，血压≤90 mmHg的休克状态（<0.001；比值比[OR]，20.1；95%置信区间[CI]，5.08 - 79.5）、对比增强计算机断层扫描上的阳性外渗（<0.001；OR 9.5，95% CI 2.85 - 31.4）、两次或更多次早期再出血事件（=0.002；OR 7.4，95% CI 2.14 - 25.4）以及出血源为右结肠（=0.023；OR 4.1，95% CI 1.25 - 14.0）是需要IR/手术治疗的独立危险因素。IR/手术组和未进行IR/手术组的早期再出血率分别为0%和28.0%（<0.001），而晚期再出血率在IR/手术组和未进行IR/手术组分别为43.4%和30.7%（=0.203）。4例需要手术治疗的患者在与初始CDB不同的部位发生了晚期再出血。
尽管IR/手术是在内镜治疗失败时有效的止血治疗方法，但无法预防晚期再出血。
