妇科手术后深静脉血栓形成高危因素的临床分析

Clinical analysis of high risk factors for deep vein thrombosis after gynecological operation

目的探讨妇科盆腔手术后深静脉血栓形成(DVT)的发生率、高危因素、临床特点及预防。方法选择2015年8月—2017年7月间妇科住院接受手术的患者,其中以36例妇科盆腔手术术后发生深静脉血栓的患者作为研究对象(血栓组),同时选择同期行妇科盆腔手术未发生血栓的145例患者作为对照组,对两组患者年龄、疾病类型、是否有合并症、手术方式、手术时间、术中出血量等进行单因素及多因素非条件Logistic回归分析。结果妇科住院接受手术患者共8 180例,妇科术后DVT发生率为0.44%,恶性肿瘤患者及非恶性肿瘤患者术后发生血栓的概率分别为3.35%及0.21%。单因素分析结果显示,妇科术后DVT的发生与高龄、肥胖、手术时间长、术中失血量多、经腹手术、恶性肿瘤、术前D-二聚体数值高、术前凝血酶原时间数值高、术前纤维蛋白原数值高、高血糖有关;多因素Logistic回归分析显示手术时间长、术前D-二聚体高、高血糖、有合并症、经腹手术方式是术后DVT发生的危险因素,与经腹手术比较,腹腔镜手术及经阴道手术方式是保护因素(P<0.05)。结论患者年龄、体质量指数、恶性肿瘤、手术方式、手术时间、术中失血量、术前D-二聚体值、术前血糖水平对妇科术后DVT发生有影响,临床实施手术前,应对相应危险因素采取预防措施,减少术后血栓形成。

Objective To investigate the incidence,risk factors,clinical characteristics and prevention of deep vein thrombosis(DVT)after pelvic operation in gynecology.Methods Patients with venous thrombosis after operation of pelvic surgery of gynecology from August2015to July2017(thrombi group)wereselected,at the same time,145patients with no thrombus as control group.A single factor and multifactor non-conditional logistic regression analysis were performed on the age of the two groups,the type of disease,the combination of complications,surgical methods,surgical time,intraoperative blood loss,etc.Results There were8180cases of gynecological inpatient surgery.The total incidence of DVT was0.44%after gynecological surgery,3.35%and0.21%of patients with malignant tumors and non-malignant tumors.The results of single-factor analysis showed that DVT occurred after gynecological surgery,which was associated with advanced age,obesity,long operation time,multiple intraoperative blood loss,abdominal surgery,malignant tumor,preoperative d-dimer,high preoperative PT value,high FIB value,and high blood glucose.Multiariable logistic regression analysis revealed that long operation time,preoperative D-dimer complications,high blood sugar,high way,abdominal surgery is a risk factor for postoperative DVT,compared with abdominal surgery,laparoscopic surgery and vaginal surgery are protective factors(P<0.05).Conclusions Patients′age,body mass index(BMI),cancer,surgical method,operation time,blood loss during operation,preoperative d-dimer value,preoperative blood glucose level havea certain effect on the formation of deep venous thrombosis after gynecological operation.Preventive measures should be taken against the corresponding risk factorsto prevent the formation of thrombosis after operation.