术后应用低分子肝素联合逐级加压弹力袜预防妇科恶性肿瘤患者静脉血栓栓塞性疾病

Prophylactic use of low molecular weight heparin in combination with graduated compressionstockings in post-operative patients with gynecologic cancer

目的探讨妇科恶性肿瘤患者术后应用低分子肝素（LMWH）联合逐级加压弹力袜预防静脉血栓栓塞性疾病（vTE）的效果。方法按照术后预防VTE的不同方法，将行根治性手术治疗的妇科恶性肿瘤初治患者分为2组，分别为LMWH联合弹力袜组和弹力袜组，分析2组患者预防VTE的效果。结果LMWH联合弹力袜组患者术后VTE的发生率为0．8％，低于弹力袜组（8．1％，P=0．01）。应用LMWH的患者术后未发生严重的出血并发症，而伤口裂开的发生率与未应用LMWH的患者比较，差异无统计学意义（P〉0．05）。多因素Logistic回归分析结果显示，年龄≥60岁、手术时间≥3h和未应用LMWH是术后发生VTE的独立危险因素（均P〈0．05）。结论妇科恶性肿瘤患者术后应用LMWH联合弹力袜预防vTE的效果高于单独应用弹力袜，且方便、安全。患者高龄和手术时间长是术后发生VrrE的危险因素，应给予积极有效的预防措施。

Objective The aim of this study was to compare the efficacy of low molecular weight heparin （LMWH） combined with graduated compression stockings （GCS） with GCS alone as prophylactic measures for venous thromboembolism （VTE） in post-operative patients with gynecologic cancer. Methods Patients diagnosed with gynecologic cancer undergoing primary major surgery between 2010 and 2011 in our institute were randomized to receive LMWH ＋ GCS or ~ as VIE prophylaxis post-operatively. Results Altogether 247 patients were enrolled. The incidence of VTE in patients treated with LMWH ＋ GCS was significantly lower than that in patients using GCS alone （0.8% Vs. 8.1% , P = 0.01 ）. There were no severe bleeding complications in the patients with prophylactic use of LMWH and the occurrence rate of wound dehiscence was comparable between the two groups （P 〉 0.05 ）. Muhivariable logistic regression analysis revealed that age over 60 years （ P = 0.015 ）, duration of operation over 3 hours （ P = 0.04 ） and without prophylactic use of LMWH （ P = 0.02） were independent risk factors for VTE. Conclusions Dual prophylaxis with LMWH and GCS should be recommended for gynecologic cancer patients undergoing major surgery for its better efficacy than GCS. Prophylactic use of LMWH is safe and convenient. Patients with older age and prolonged operation time are at highest risk of developing VTE post-operatively.