Research On The Influencing Factors Of Delayed Bleeding After Endoscopic Submucosal Dissection Of Colorectal Tumors

Objective:The concept of disease prevention runs through the whole process of disease occurrence,development and outcome.There is a serious risk of delayed bleeding after endoscopic submucosal dissection(ESD)in the treatment of pseudulcer caused by colorectal tumors.However,existing studies have failed to pay attention to the preventive significance of delayed bleeding after ESD.Although some studies have found risk factors for delayed bleeding after colorectal ESD surgery,different studies have reached different conclusions.At present,there is a lack of effective secondary prevention measures to prevent delayed bleeding after ESD surgery.Therefore,this paper aims to explore the related factors affecting postoperative delayed bleeding,so as to provide practical guidance for promoting the physical and mental health of patients with colorectal tumor and formulating scientific and effective postoperative bleeding prevention and control policies.Methods:This study retrospectively collected the information of patients diagnosed with colorectal tumor and hospitalized with colorectal ESD from January 2018 to July 2022 in the Department of Gastroenterology,The First Affiliated Hospital of China Medical University.The information was summarized into three categories,including basic characteristics of patients,lesion-related characteristics and preoperative relevant laboratory indicators of patients.The incidence of delayed bleeding after colorectal ESD was statistically analyzed.Chi-square test or Fisher Chi-square were used to compare the rate of delayed bleeding after colorectal ESD in different target population.Then,multivariate Firth Logistic regression model was used to analyze the independent influencing factors of delayed bleeding after ESD in the general population.All subjects were grouped according to different ages and genders,and the independent influencing factors of delayed bleeding after ESD in different groups were analyzed by multivariate Firth Logistic regression.Results:1.In this study,a total of 824 patients with colorectal tumor were investigated.Delayed bleeding occurred in 26 cases after Endoscopic submucosal dissection,with a bleeding rate of 3.16%.The bleeding time was mainly concentrated within 2 to 6 days after Endoscopic submucosal dissection.2.Analysis of the current status of delayed postoperative bleeding in different groups showed that:In patients with different age(P=0.047),gender(P=0.004),lesion site(P<0.001),lesion size(P=0.001),pathological type(P=0.019),operation time(P=0.037),platelet number(P=0.022)and whether submucosal fibrosis occurred(P=0.025),the postoperative delayed bleeding rate was statistically significant(P<0.05).3.Multivariate Firth Logistic regression analysis of postoperative delayed bleeding showed that:In the general population,Age≤50 years old,male,low platelet count,lesions>40 mm and lesions located in the rectum were independent factors for postoperative delayed bleeding.4.Analysis of postoperative delayed bleeding in different age groups showed that:In patients aged less than or equal to 50 years old,smoking and lesions>40 mm were independent influencing factors of postoperative delayed bleeding.In patients older than 50 years,male,hypertension,low platelet count,lesions>40 mm and lesion located in the rectum were independent risk factors for postoperative delayed bleeding.5.Analysis of postoperative delayed bleeding in different gender groups showed that:In male patients,lesions>40 mm,and lesion located in the rectum were independent influencing factors of postoperative delayed bleeding.In female patients,lesions>40 mm were independent risk factors for postoperative delayed bleeding.Conclusion:1.The rate of delayed bleeding after ESD surgery for colorectal tumors was 3.16%,and the rate of delayed bleeding in patients younger than or equal to 50 years old was significantly higher than that in patients over 50 years old.2.In the general population,Age ≤50 years old,male,low platelet count,lesions>40 mm,and lesions located in the rectum may be the influencing factors of delayed bleeding after colorectal ESD.3.According to the analysis of the influencing factors of delayed bleeding after ESD in different age groups and different gender groups,the lesion>40 mm is the common independent influencing factor of different age and gender groups.