结直肠内镜黏膜下剥离术中出血的危险因素分析

Analysis of risk factors for intraoperative bleeding in colorectal endoscopic submucosal dissection

摘要:

目的 分析结直肠内镜黏膜下剥离术（ESD）术中出血的危险因素。方法 回顾性分析2024年2月—2026年2月邯郸市第一医院97例行结直肠ESD患者的临床资料，根据术中是否发生可见出血，将患者分为出血组（21例）及未出血组（76例）。比较两组的临床资料，采用多因素一般Logistic回归模型分析结直肠ESD术中出血的独立危险因素。结果 出血组合并糖尿病发生率、术前抗血小板药物停药时间<5 d及停药5～7 d占比、病灶形态为侧向发育型及凹陷型占比、病灶最大直径、病灶浸润深度为黏膜下层占比、病理类型为早期癌占比均高于未出血组（P <0.05）。合并糖尿病［O^R =7.162（95% CI：1.169，43.876）］、病灶形态为侧向发育型［O^R =6.428（95% CI：1.190，34.731）］、病灶最大直径较大［O^R =3.543（95% CI：1.730，7.255）］、病灶浸润深度为黏膜下层［O^R =5.452（95% CI：1.077，27.612）］、病理类型为早期癌［O^R =6.966（95% CI：1.384，35.056）］均为结直肠ESD术中出血的独立危险因素（P <0.05）；术前抗血小板药物停药时间≥7 d［O^R =0.079（95% CI：0.014，0.448）］为结直肠ESD术中出血的独立保护因素（P <0.05）。结论 合并糖尿病、病灶形态为侧向发育型、病灶最大直径较大、浸润深度达黏膜下层、病理类型为早期癌是结直肠ESD术中出血的独立危险因素，而术前抗血小板药物停药时间≥7 d是独立保护因素。临床应重点关注存在上述危险因素的患者，加强围手术期管理，以降低术中出血风险。

Abstract:

Objective To analyze the risk factors for intraoperative bleeding during colorectal endoscopic submucosal dissection (ESD).Methods The clinical data of 97 patients who underwent colorectal ESD at Handan First Hospital from February 2024 to February 2026 were retrospectively analyzed. According to whether visible bleeding occurred during the procedure, the patients were divided into a bleeding group (n = 21) and a non-bleeding group (n = 76). Clinical data were compared between the two groups, and multivariate logistic regression was used to analyze independent risk factors for intraoperative bleeding during colorectal ESD.Results The proportions of patients with diabetes; preoperative antiplatelet drug discontinuation for < 5 days or 5-7 days; laterally spreading or depressed lesions; submucosal invasion; and early cancer, as well as the maximum lesion diameter, were higher in the bleeding group than in the non-bleeding group (P < 0.05). Diabetes [O^R = 7.162 (95% CI: 1.169, 43.876) ], laterally spreading lesions [O^R = 6.428 (95% CI: 1.190, 34.731) ], larger maximum lesion diameter [O^R = 3.543 (95% CI: 1.730, 7.255) ], submucosal invasion [O^R = 5.452 (95% CI: 1.077, 27.612) ], and early cancer [O^R = 6.966 (95% CI: 1.384, 35.056) ] were risk factors for intraoperative bleeding during colorectal ESD (P < 0.05), whereas preoperative discontinuation of antiplatelet drugs for ≥ 7 days [O^R = 0.079 (95% CI: 0.014, 0.448) ] was a protective factor (P < 0.05).Conclusion Diabetes, laterally spreading lesions, larger maximum lesion diameter, invasion into the submucosa, and early cancer are independent risk factors for intraoperative bleeding during colorectal ESD, whereas preoperative discontinuation of antiplatelet drugs for ≥ 7 days is an independent protective factor. Patients with these risk factors should be closely monitored, and perioperative management should be strengthened to reduce the risk of intraoperative bleeding.