妇科手术后静脉血栓性疾病27例临床分析

Clinical Analysis of 27 Cases with Venous Thrombotic Disease after Gynecologic Surgery

目的:探讨妇科手术后静脉血栓性疾病(VTE)的发生率、危险因素及其诊断和治疗。方法:回顾性分析我院2003年1月至2008年11月期间,确诊为妇科手术后VTE 27例患者的临床情况,其中下肢静脉血栓(DVT)26例,肺栓塞(PE)1例。结果:妇科手术后VTE总发生率为0.27%,其中恶性肿瘤1.59%,良性疾病0.02%,恶性肿瘤明显高于良性疾病(P<0.01)。卵巢癌的VTE发生率为3.43%,明显高于宫颈癌(0.71%)和子宫内膜癌(0.74%)(P<0.05)。行盆腔淋巴结清扫显著增加VTE发生率。DVT患者经彩色多普勒超声检查确诊,PE患者经CT肺血管三维扫描确诊。结论:妇科盆腔手术后VTE发生率低,但有增加趋势。恶性肿瘤,尤其是卵巢癌和行盆腔淋巴结清扫术是VTE发生的危险因素。正确诊断、及时治疗愈后好。

Objective：To investigate the incidence and risk factors of venous thrombotic disease （VTE）in women after gynecological surgery. Methods：A retrospective study of total of 27 VTE patients after gynecologic surgery from January 2003 to November 2008 in our hospital was done, including 26 patients with DVT and one patient with pulmonary thromboembolism （PE）. Results：The total incidence of VTE was 0.27% after gynecologic surgery, of which malignant tumor accounted 1.59%, benign disease was 0.02%. The incidence of VTE after malignant tumor surgery was significantly higher than that after benign disease surgery （P〈0.01）. The incidence of VTE in ovarian cancer patients was 3.43%, significantly higher than that in cervical cancer （0.71% ） and endometrial cancer （0.74%） （ P 〈 0.05）. VTE incidence was significantly increased after pelvic lymph node dissection. DVT was diagnosed by colourful doppler sonography, and PE was found by spiro CT of the lung. Conclusions：VTE is rare in Chinese patients undergoing gynecological surgery, but there is a trend for increasing. Malignant tumor, especially ovarian cancer and pelvic lymph node dissection are potential risk factors of VTE. Accurate diagnose and early treatment will lead to a good prognosis.