国产与进口止血夹预防≥10 mm结直肠息肉内镜切除术后迟发性出血的效果对比

Comparison of domestic and imported hemostatic clips in preventing delayed post‑polypectomy bleeding after endoscopic resection of colorectal polyps larger than 10 mm

摘要:

目的 对比国产与进口止血夹预防≥10 mm结直肠息肉内镜切除术后迟发性出血的效果。方法 收集2018年1月—2019年12月于首都医科大学附属北京友谊医院行结直肠息肉（长径≥10 mm）内镜下切除术的789例患者的临床资料。将患者分为术后迟发性出血组（n=15）与未出血组（n=774），采用单因素以及多因素Logistic回归模型分析术后迟发性出血的影响因素。另外将使用1种类型止血夹的患者按所采用的止血夹品牌，分为国产组（n=499）以及进口组（n=208），对比两组止血夹预防术后迟发性出血的效果。结果 789例行结直肠息肉内镜下切除术的患者中，1.9%（15/789）的患者术后出现迟发性出血。多因素Logistic回归分析显示有蒂息肉是术后迟发性出血的独立危险因素（OR=6.621，95%CI：2.278~19.241，P=0.001），止血夹封闭创面是术后迟发性出血的独立保护因素（OR=0.169，95%CI：0.050~0.570，P=0.004）。无论医师经验高低，国产组与进口组止血夹预防≥10 mm结直肠息肉内镜切除术后迟发性出血的效果差异无统计学意义［有经验医师亚组：1.8%（7/385）比0.6%（1/175），χ2=1.314，P=0.445；普通医师亚组：2.6%（3/114）比3.0%（1/33），χ2=0.010，P>0.999］，且国产组相比于进口组患者使用止血夹费用更少［有经验医师亚组：（1 433.51±889.02）元比（3 033.97±1 686.87）元，t<0.001，P<0.001；普通医师亚组：（1 181.58±815.29）元比（3 303.46±1 690.43）元，t<0.001，P<0.001］。结论 有蒂息肉是≥10 mm结直肠息肉内镜切除术后迟发性出血的独立危险因素，止血夹封闭创面可以显著降低术后迟到性出血的风险。国产止血夹与进口止血夹相比，预防术后迟发性出血效果并无差异，但国产止血夹相比于进口止血夹医疗负担更小，适于向基层医院以及各大临床中心推广。

Abstract:

Objective To compare the efficacy of domestic and imported hemostatic clips in preventing delayed post-polypectomy bleeding (DPPB) after endoscopic resection of colorectal polyps ≥ 10 mm. Methods Clinical data of 789 patients who underwent endoscopic resection of colorectal polyps (polyp diameter ≥10 mm) in Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2019 were collected. The patients were divided into DPPB group (n=15) and non-DPPB group (n=774). Univariate and multivariate logistic regression models were used to analyze the influential factors for DPPB. The patients using one type of hemostatic clip were divided into the domestic hemostatic clip group (n=499) and the imported hemostatic clip group (n=208). The efficacy of hemostatic clips in preventing DPPB in the two groups was compared. Results Among the 789 patients undergoing endoscopic resection of colorectal polyps, 1.9% (15/789) suffered from DPPB. Multivariate logistic regression analysis showed that pedunculated polyp was an independent risk factor for DPPB (OR=6.621, 95%CI: 2.278-19.241, P=0.001), and closure of mucosal defect was an independent protective factor for DPPB (OR=0.169,95%CI: 0.050-0.570, P=0.004). Regardless of physician experience, there was no significant difference between the domestic and imported hemostatic clip group in preventing DPPB after endoscopic resection of colorectal polyps ≥10 mm [experienced physicians: 1.8% (7/385) VS 0.6% (1/175), χ2=1.314, P=0.445; common physicians: 2.6% (3/114) VS 3.0% (1/33), χ2=0.010, P>0.999]. The domestic hemostatic clip group paid for less medical expenses than the imported hemostatic clip group (experienced physicians: 1 433.51±889.02 yuan VS 3 033.97±1 686.87 yuan, t<0.001, P<0.001; common physicians: 1 181.58±815.29 yuan VS 3 303.46±1 690.43 yuan, t<0.001,P<0.001). Conclusion Pedunculated polyp is an independent risk factor for DPPB after endoscopic resection of colorectal polyp larger than 10 mm, and clipping can significantly reduce the risk for DPPB. There is no significant difference in the prevention of DPPB between domestic and imported clips, but domestic clips compared with imported clips yield less medical burden, which are suitable for promotion to primary hospitals and major clinical centers.