CAJ | 학술논문

目的探讨内镜下治疗结肠侧向发育型肿瘤后延迟出血发生的原因和治疗对策。方法分析了2001年9月至2011年9月来我院行内镜下治疗（包括内镜下黏膜切除术和内镜黏膜下剥离术）结肠侧向发育型肿瘤后延迟出血患者的临床资料，统计分析以下相关因素：（1）术前因素：如性别、年龄、伴发高血压、糖尿病及其他慢性病，既往服用抗凝药物，病变大小、部位等情况；（2）术中因素：病变切除情况，创面的处理方法，操作时间；（3）术后因素：患者饮食和活动量控制不理想。结果1867例患者纳入研究，其中内镜下切除术后发生延迟出血34例。术后延迟出血的发生与病变长度、创面的处理方法以及术后患者饮食和活动的控制密切相关（P＜0.05），而与患者的性别、部位、伴发病、既往是否服用抗凝药物、病变部位、病变切除情况、操作时间关系无显著性（ P＞0.05）。结论病变长度、创面的处理方法以及术后患者饮食和活动的控制是影响术后延迟出血发生率的重要因素，对于较大的结肠侧向发育型肿瘤应予以充分重视，应选择有效的创面处理方法并严格控制术后饮食和活动，预防延迟出血的发生。
목적탐토내경하치료결장측향발육형종류후연지출혈발생적원인화치료대책。방법분석료2001년9월지2011년9월래아원행내경하치료（포괄내경하점막절제술화내경점막하박리술）결장측향발육형종류후연지출혈환자적림상자료，통계분석이하상관인소：（1）술전인소：여성별、년령、반발고혈압、당뇨병급기타만성병，기왕복용항응약물，병변대소、부위등정황；（2）술중인소：병변절제정황，창면적처리방법，조작시간；（3）술후인소：환자음식화활동량공제불이상。결과1867례환자납입연구，기중내경하절제술후발생연지출혈34례。술후연지출혈적발생여병변장도、창면적처리방법이급술후환자음식화활동적공제밀절상관（P＜0.05），이여환자적성별、부위、반발병、기왕시부복용항응약물、병변부위、병변절제정황、조작시간관계무현저성（ P＞0.05）。결론병변장도、창면적처리방법이급술후환자음식화활동적공제시영향술후연지출혈발생솔적중요인소，대우교대적결장측향발육형종류응여이충분중시，응선택유효적창면처리방법병엄격공제술후음식화활동，예방연지출혈적발생。
Objective To evaluate the treatment projects and reasons of delayed bleeding in endoscopic treatment of laterally spreading colon tumor ( LST) .Methods Clinical data of patients between September 2001 and September 2011 were collected in this study .The following factors associated with bleeding were analyzed:( 1 ) preoperative factor: sex, age, concomitant diseases including hypertension and diabetes mellitus , history of administration of anticoagulants or anti-platelet agents , lesion size and location;( 2 ) intraoperative factor:en-bloc resection,wound treatment and operation time;(3) postoperative factor:patient′s diet and activity control. Results 1867 patients were enrolled in this study ,in which 34 patients were occurred with delayed bleeding .The occurrence of delayed bleeding was closely related to lesion size ,wound treatment methods ,and postoperative diet and activities of patients ( P <0.05 ), and there was little relation with sex, location, co-morbidity, previous taking anticoagulant drugs and operation time ( P >0.05 ) .Conclusions Lesion size, wound treatment methods , and postoperative diet and activities of patients were important factors to affect the postoperative delayed bleeding . Adequate priority should be given to large size LST ,and effective wound management should be chosen .Therefore, with strict control of postoperative diet and activities ,we can reduce the incidence of delayed bleeding .