J Gastroenterol Hepatol：息肉切除术后迟发性出血的风险因素

　　息肉切除术后迟发性出血是一种罕见但严重的并发症。近日，来自韩国的研究者Jeong Ho Kim发表论文，旨在确定息肉切除术后发展成迟发性出血的风险因素。该研究指出，息肉的大小、形状和位置代表结肠镜下息肉切除术后迟发性出血的实质性风险因素。该文发表在2013年第28卷第4期《胃肠病学与肝脏病学杂志》上。

　　这是一项对接受结肠镜下息肉切除术后发展为迟发性便血患者的回顾性病例对照研究。对照组患者接受常规接受息肉切除术，被选比例为4:1。

　　在3253例接受结肠镜下息肉切除术患者的7447个病灶中，42例（1.3%）患者的53个（1.7%）病灶发展成为迟发性出血，168例患者被作为对照组。根据多变量逻辑回归分析法，息肉大于10毫米（比值比[OR] 2.355，95% 置信区间[CI]1.225-4.528，P＝0.010），有蒂息肉（OR 3.473，95%CI 1.576-7.657，P＝0.002），息肉位于右半结肠（OR 2.690，95%置信区间 1.465-4.940，P＝0.001），为息肉切除术迟发性出血的重要风险因素。并发症的存在不会增加迟发性出血风险。

与息肉相关的拓展阅读： 

• Gastroenterology:10%的肿瘤性息肉可能未被完全切除
• Gastrointest Endosc：EMR治疗难治性息肉的新经验
• USMSTF发布新的《结肠镜检查及息肉切除术后随访指南》
• 新内镜技术可避免对所有息肉进行病理检查 更多信息请点击：有关息肉更多资讯

Risk factors for delayed post-polypectomy hemorrhage: A case-control study
BACKGROUND AND AIM
Delayed post-polypectomy hemorrhage is a rare but serious complication. The aim of this study was to identify risk factors for the development of delayed post-polypectomy hemorrhage.
METHODS
This was a retrospective case-control study of patients who developed delayed hematochezia after receiving colonoscopic polypectomy. The control patients underwent uneventful polypectomy and were selected at a 4:1 ratio.
RESULTS
Of the 7447 lesions examined from the 3253 patients who received colonoscopic polypectomy, 53 lesions (0.7%) of 42 patients (1.3%) developed delayed hemorrhage, and 168 patients were selected as controls. According to multivariate logistic regression analysis, a polyp larger than 10 mm (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.225-4.528, P = 0.010), a pedunculated polyp (OR 3.473, 95% CI 1.576-7.657, P = 0.002), and a polyp located in the right hemi-colon (OR 2.690, 95% CI 1.465-4.940, P = 0.001) were significant risk factors for delayed post-polypectomy hemorrhage. The presence of comorbidities did not increase the risk of delayed hemorrhage.
CONCLUSION
Polyp size (large), shape (pedunculated), and location (right hemi-colon) represented substantial risk factors for the development of delayed hemorrhage after colonoscopic polypectomy.