结直肠息肉内镜微创术后并发症发生的影响因素分析

Analysis of factors influencing the occurrence of complications after endoscopic minimally invasive surgery for colorectal polyps

摘要:

目的 探讨结直肠息肉内镜微创术后并发症发生的影响因素。方法 回顾性分析2023年7月—2024年6月铜陵市人民医院消化内科收治的282例结直肠息肉患者的临床资料。所有患者行内镜下黏膜切除术（EMR）或结肠镜下氩离子凝固术，术后电话随访3个月，依据患者术后是否发生并发症分为合并组和未合并组，分别有57、225例。比较两组患者基线数据，分析结直肠息肉内镜微创术后发生并发症的影响因素及其对术后并发症的预测价值，统计两组患者并发症发生情况。结果 合并组年龄大于未合并组（P <0.05），手术时间长于未合并组（P <0.05），合并组息肉直径> 2 cm占比、术中上金属夹占比、血清CRP水平均高于未合并组（P <0.05）。多因素逐步Logistic回归分析结果显示：年龄大［O^R=1.237（95% CI：1.163，1.315）］、息肉直径> 2 cm ［O^R=7.358（95% CI：3.906，13.862）］、血清CRP水平高［O^R=2.294（95% CI：1.837，2.865）］、手术时间长［O^R=1.550（95% CI：1.363，1.763）］及术中上金属夹［O^R=3.658（95% CI：1.087，12.313）］均为结直肠息肉内镜微创术后并发症的危险因素（P <0.05）。各项联合预测术后并发症的曲线下面积为0.979（95% CI：0.896，1.000），敏感性为96.50%（95% CI：0.856，1.000），特异性为96.00%（95% CI：0.873，1.000）。共67例患者出现术后并发症。结论 结直肠息肉内镜微创术患者术前年龄越大、息肉直径> 2 cm、血清CRP水平越高，且手术时间越长、术中上金属夹均可提高术后并发症发生风险，并可辅助预测术后是否发生并发症。

Abstract:

Objective To analyze the factors influencing the occurrence of complications after endoscopic minimally invasive surgery for colorectal polyps.Methods The clinical data of 282 patients with colorectal polyps admitted to the Department of Gastroenterology of Tongling People's Hospital from July 2023 to June 2024 were retrospectively analyzed. All patients underwent EMR surgery or argon plasma coagulation under colonoscopy, and a telephone follow-up was conducted for 3 months postoperatively. Patients were divided into the combined group (n = 57) and the non-combined group (n = 225) according to whether complications occurred after surgery. The baseline data of the two groups were compared. The factors affecting the occurrence of complications after endoscopic minimally invasive surgery for colorectal polyps and their predictive values for postoperative complications were analyzed. The incidence of complications in the two groups was recorded.Results The age of patients in the combined group was older than that in the non-combined group (P < 0.05). The operative duration in the combined group was longer than that in the non-combined group (P < 0.05). The proportion of patients with polyps > 2 cm in diameter, the proportion of patients using metallic clips during surgery, and the serum CRP level in the combined group were higher than those in the non-combined group (P < 0.05). The multivariable Logistic regression analysis (P = 0.05 for including variables and P = 0.10 for excluding variables) showed that older age [O^R = 1.237 (95% CI: 1.163, 1.315) ], polyp diameter > 2 cm [O^R = 7.358 (95% CI: 3.906, 13.862) ], higher serum CRP levels [O^R = 7.358 (95% CI: 1.837, 2.865) ], longer operative duration [O^R = 1.550 (95% CI: 1.363, 1.763) ] and intraoperative use of metallic clips [O^R = 3.658 (95% CI: 1.087, 12.313) ] were all risk factors for the occurrence of complications after endoscopic minimally invasive surgery for colorectal polyps (P < 0.05). The area under the curve of the combination of all indicators for predicting postoperative complications was 0.979 (95% CI: 0.896, 1.000), with a sensitivity of 96.50% (95% CI: 0.856, 1.000), and a specificity of 96.00% (95% CI: 0.873, 1.000). A total of 67 patients experienced postoperative complications.Conclusions Older age, polyps > 2 cm in diameter, higher serum CRP levels, longer operative duration, and use of metallic clips during the operation may all increase the risk of occurrence of complications after endoscopic minimally invasive surgery for colorectal polyps, and they could assist in predicting the occurrence of postoperative complications.