肿瘤细胞减灭加腹腔热灌注化疗术后静脉血栓栓塞症的预防

Venous thromboembolism prevention for peritoneal carcinomatosis patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

目的:评估行肿瘤细胞减灭术(cytoreductive surgery,CRS)加腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗的腹膜癌患者静脉血栓栓塞症(venous thromboembolism,VTE)发生风险,研究术后早期主/被动活动联合间歇充气加压按摩对VTE的预防效果。方法:对2015年5月至2016年8月武汉大学中南医院肿瘤科收治的120例胃肠道及妇科肿瘤等来源的腹膜癌患者行CRS+HIPEC治疗,使用Caprini血栓风险评估模型评价VTE风险,所有患者采取早期肢体主/被动活动及间歇充气加压按摩治疗,记录分析VTE相关事件。结果:患者中位Carprini评分为12(10~16)分,均为VTE极高危组,在3个月的随访中仅1例患者发生深静脉血栓,经药物治疗后痊愈。结论:腹膜癌患者VTE风险极高,术后早期足背曲/跖曲及扩胸等主/被动运动联合间歇充气加压按摩,可有效预防VTE。

Objective： To assess the venous thromboembolism （VTE） risk and evaluate the effectiveness of combined physical exercise and intermittent pneumatic compression device treatment in thromboprophylaxis among peritoneal carcinomatosis （PC） patients treated by cytoreductive surgery （CRS） and hyperthermic intraperitoneal chemotherapy （HIPEC）. Methods： A total of 120 CRS＋HIPEC procedures were performed on 120 consecutive patients with PC from gastrointestinal and gynecological malignancies. The Caprini risk factor score was adopted to evaluate the VTE risk for each patient. For VTE prevention, a systematic physiotherapy program comprising active exercises of both arms and legs, as well as intermittent pneumatic compression device treatment, was developed. This physiotherapy was applied to all patients, and the VTE-related events were recorded and analyzed. Results： The median Caprini risk factor score was 12 （range, 10-16）; all patients were at the highest VTE risk. The systematic physiotherapy program was applied to all patients during the perioperative period, and no clinically symptomatic VTE events were observed during the hospitalization treatment after operation. During the 3-month follow-up period, only i of the 120 patients developed right-leg deep-vein thrombosis, which was cured after drug treatment. Conclusion： PC patients treated by CRS ＋ HIPEC are at the highest risk for VTE. The systematic physiotherapy program can effectively prevent VTE in such patients.