肺癌手术患者出院后静脉血栓栓塞危险因素分析

Risk ractors of venous thromboembolism following lung cancer resection

目的探究肺癌术后患者出现静脉栓塞的危险因素。方法回顾性分析2005年至2015年在本中心接受肺癌手术患者及出院后出现静脉栓塞患者的临床资料。使用多变量分析患者出院后出现静脉栓塞的危险因素。结果全组7154例117例(1.6%)术后发生静脉栓塞,其中51例(43.6%)在出院后发生静脉栓塞。全肺切除术患者出院后静脉栓塞发生率为肺叶切除术后患者的3倍(2.03%对0-64%,P<0.01),开放手术较腔镜下手术患者出院后静脉中栓塞发生率差异有统计学意义(0.86%对0.53%.P<0.01),手术时间较长(>75%患者)静脉栓塞发生率也较高。高龄、肥胖、全肺切除术、手术时间较长是术后发生静脉栓塞的独立危险因素。结论静脉栓塞主要发生在出院后,且大部分患者未接受正规的预防治疗。对存在静脉栓塞高危因素的患者,尤其是老年肥胖患者,出院后需进行预防治疗。

Objective To identify risk factors for posldischarge venous lhromboembolisni( VIE)following lung resection. Methods Palicnls undergoing anatomic resection for lung cancer were identified in our institution from 2005 -2015. Patient demographic and clinical characteristics were evaluated for any association with post-discharge VTE. Predictors of post-discharge VTE were idenlified using multivariable analysis. Results VTE occurred in 1.6%(117) of the 7 154 patients identified. 43. 6%(51 ) VTE events occurred following hospital discharge. Undergoing pneumonectomy was associated with a threefold increased risk for post-discharge VTE compared with lobectomy (2. 03% vs. 0. 64%, P <0.01 ), as was open resection compared to minimally invasive resection(0. 86% vs. 0. 53%, P <0. 01 ). Prolonged operative time(> 75%) was also associated with increased risk for post-discharge VTE compared to shorter operative time. Multivariable analysis identified older age, obesity, pneumonectomy, and prolonged operative time as independent predictors for post-discharge VTE. Conclusion Tlie risk for VTE extends after hospital discharge, few patients are managed with post-discharge prophylaxis. Post-discharge prophylaxis should be considered for those at high risk for VTE, particularly for older patients, those who are obese, and following extended or lengthy resections.