妇科恶性肿瘤患者术后静脉血栓栓塞的高危因素分析

The analysis of the high risk factors of postoperative venous thromboembolism of gynecological cancer patients

目的:探讨妇科恶性肿瘤患者术后静脉血栓栓塞疾病(VTE)发生的危险因素及其预防措施。方法:回顾分析32例北京大学人民医院诊治的术后VTE的妇科恶性肿瘤患者临床资料,并与具有相同高危因素,包括高血压、糖尿病、高血脂但术后未发生VTE的61例妇科恶性肿瘤患者的临床资料进行对比分析。结果:血栓组与对照组比较,脂肪肝(χ2=5.056,P=0.025)、术后化疗(χ2=13.657,P<0.001)及围手术期给予止血药物(χ2=12.007,P=0.001)明显增加VTE的发生率,而术中化疗(χ2=8.233,P=0.004)及术后采用抗凝等预防措施(χ2=18.582,P<0.001)则显著降低VTE的发生率。而其余因素两组间无统计学差异。Logistic回归分析提示围手术期给予止血药物与术后VTE的关系最密切,OR为6.129(1.242,30.239)。VTE使得患者住院时间明显延长(P=0.010)。结论:妇科恶性肿瘤患者术后发生VTE的可能性大,术前应进行危险因素评估,对于合并高血压、糖尿病、高血脂、脂肪肝、术后化疗以及围手术期接受止血药物治疗的患者,应采取积极的多种联合预防措施,以减少术后VTE的发生。

Objective：To investigate the risk factors and prevention of postoperative venous thromboembolism（VTE） of gynecological cancer patients.Methods：A retrospective comparison study between 32 cases gynecologic cancer patients who diagnosed with postoperative VTE and 61 cases gynecological cancer patients with same risk factors of thrombosis formation（including hypertension,diabetes mellitus and hyperlipemia）but without VTE after operation.Results：Fatty liver（χ2=5.056,P=0.025）,postoperative chemotherapy（χ2=13.657,P0.001）,haemostatic treatment（χ2=12.007,P=0.001） increased the incidence of VTE obviously;adversely,intraoperative chemotherapy（χ2=8.233,P=0.004）,postoperative anticoagulation（χ2=18.582,P0.001） decreased the incidence of VTE significantly.The other factors were not statistical differences between the two groups.Logistic regression analysis suggests haemostatic treatment was most directly related to postoperative VTE,and odds ratio was 6.129（1.242,30.239）.Postoperative VTE prolonged hospitalization obviously（P=0.010）.Conclusions：VTE is highly increased in postoperative gynecological cancer patients.As a result,risk factors assessment is suggested before operation.Positive and joint postoperative preventions are recommended for patients with risk factors including hypertension,diabetes mellitus,hyperlipidemia,fatty liver,postoperative chemotherapy and haemostatic treatment.