静脉瘀滞指数评估妇科恶性肿瘤切除术后下肢深静脉血栓发生风险

Using stasis index of vein to assess the risk of lower extremity deep venous thrombosis after gynecologic malignant tumor resection

目的探讨静脉瘀滞指数对妇科恶性肿瘤患者切除术后下肢深静脉血栓风险评估的价值。方法选取妇科恶性肿瘤患者165例于术前及术后分别行常规下肢深静脉彩色多普勒超声检查,术前及术后均测量股总静脉内径(DFV)及其平均流速(V),并由此计算出静脉瘀滞指数(SI),根据术后超声结果分为血栓组与非血栓组,统计两组年龄、体重指数(BMI)、糖尿病史、高血压病史、肿瘤位置、肿瘤分期、术后卧床时间、凝血功能及上述超声测值等指标,采用Logistic回归分析下肢深静脉血栓形成与上述因素相关性。结果1)血栓组19例,非血栓组146例,血栓发生率为11.52%;2)Logistic回归结果提示,肿瘤分期(P=0.029,OR值=3.545,95%可信区间为1.134~11.081)、BMI(P=0.035,OR值=1.132,95%可信区间为1.009~1.270)、SI(P=0.017,OR值=1.265,95%可信区间为1.042~1.535)为妇科恶性肿瘤术后下肢深静脉血栓发生的危险因素;3)根据ROC曲线,静脉瘀滞指数(SI)诊断妇科恶性肿瘤术后下肢深静脉血栓曲线下面积(AUC)为0.878(P<0.05),预测血栓发生的截点值为9.853,其敏感性88.9%、特异性84.3%。结论妇科恶性肿瘤切除术后患者下肢深静脉血栓的发生率较高,肿瘤分期、体重指数及静脉瘀滞指数是血栓发生的危险因素,静脉瘀滞指数可用于评价术后下肢深静脉血栓发生的风险。

Objective To discuss the risk of loweRextremity deep venous thrombosis (DVT) in patients with resection of the gynecologic malignant canceRwith stasis index. Methods We included 165 patients with resection of the gynecologic malignant tumor. Femoral vein diameteR(D FV ), mean blood flow velocity (V) and stasis index of vein (SI) were measured before and afteRsurgery. 165 patients were divided into thrombosis group and non-thrombosis group according to ultrasonography afteRsurgery. The differences of age, body mass index, diabetes, hypertension, tumoRlocation, tumoRstage, coagulation and ultrasonography indicatoRbetween thrombosis and non-thrombosis group were compared. Results Thrombosis group comprised 19 patients (11.52%). TumoRstage 〔odds ratio (OR): 3.545, 95% confidence interval (CI): 1.134,11.081〕, BMI (OR:1.132, 95%CI: 1.009,1.270) and SI (OR: 1.265, 95%CI: 1.042, 1.535) were independent predictors foRDVT. Area undeRthe ROC curve foRSI was 0.878 (95% CI: 0.792, 0.963). The cut-off value of SI was 9.853. The sensitivity and specificity foRSI were 88.9%, 84.3%, respectively. Conclusion TumoRstage, BMI and SI were independent predictors foRloweRextremity deep venous thrombosis. Stasis index can assess the risk of loweRextremity DVTs in patients with resection the gynecologic malignant tumor.