子宫切除术后下肢深静脉血栓形成的危险因素及手术方式影响的研究

Risk factors and the effect of surgical methods on lower extremity deep vein thrombosis after hysterectomy

目的探索子宫切除术后下肢深静脉血栓形成(DVT)的发病率、风险因素,以及不同手术方式对术后下肢DVT的影响。方法回顾性分析上海同济大学附属医院2001年1月1日至2016年11月30日行子宫切除术患者的临床资料。对比分析发生与未发生术后下肢DVT患者的相关数据,利用双变量分析探讨术后DVT相关的危险因素。并进一步分析经腹入路、腹腔镜以及经阴道入路3种术式对子宫切除术后DVT的影响。结果术后DVT的发病率为2%(220/10248)。术后下肢DVT的发生与体重指数(BMI)、经腹子宫切除术、妇科恶性肿瘤、手术时间和术后卧床时间密切相关(P<0.05);子宫切除术后下肢DVT在经腹入路相较非经腹入路的似然比为2.69,95%可信区间为1.46~4.95;但腹腔镜术后下肢DVT患者中漂浮型血栓比率(67%)较经腹开放术后下肢DVT患者(29%)显著增高。结论BMI、经腹子宫切除术、手术时间、妇科恶性肿瘤和术后卧床时间是子宫切除术后下肢DVT的危险因素。腹腔镜手术较开放手术术后下肢DVT发生率低,但更需要早期预防降低肺梗塞发生的风险。

Objective To identify the morbidity and risk factors on deep vein thrombosis （DVT） after hysterectomy, and the effects of different surgical procedures on postoperative DYT. Methods This study was a retrospective analysis which included the information and perioperative data on patients who were operated with hysterectomy during the period from January 1,2001 to November 30, 2016 in the Affiliated Hospital of Shanghai Tongji University. Patients suffered from postoperative DVT were compared to those normal patients, and the double variant was used to analyze the important variables related to DYT; moreover, the impact of three surgical methods, namely, transabdominal approach, laparoscopy and transvaginal approach on DVT after hysterectomy was further analyzed. Results The incidence of postoperative DVT was 2% （220/10,248）. The occurrence of postoperative DVT was closely associated with the body mass index （P〈 0.001）, transabdominal hysterectomy （P=0.001）, gynecological malignancy （P=0.01） and operation time （P〈 0.001） as well as postoperative bed-rest time （P=0.001）. The likelihood ratio of DVT after hysterectomy between transabdominal approach and non-transabdominal approach was 2.67, and 95% confidence interval was 1.46-4.86. However, after laparoscopic surgery, the rate of floating thrombosis in patients with DYT （67%） was significantly higher than that in patients with DVT after transabdominal open surgery （29%）. Conclusion Body mass index, transabdominal hysterectomy, operation time, gynecological malignancy and postoperative bed-rest time were the risk factors of DVT after hysterectomy. The incidence of DYT after la-paroscopic surgery was lower than that after the open surgery, but early prevention was more needed, as the increased risk of Pulmonary embolism.