肾癌围手术期血栓弹力图评估凝血状态的临床研究

A clinical study of thrombelastogram in perioperative patients with renal cell carcinoma to evaluate coagulation status

目的:探讨血栓弹力图(thrombelastogram,TEG)评估肾癌患者围手术期凝血状态的临床应用价值,并研究TEG与凝血功能主要指标的相关性。方法:选取2016年1月至2018年3月在我院行肾占位性病变手术的患者142例,并根据术后病理结果将患者分为肾癌组(97例)与肾良性疾病组(45例)。分别用TEG和常规凝血检测评估两组患者围手术期的凝血功能差异,评价两种凝血方法的临床价值。再将肾癌组单独分析,比较肾癌患者TEG与常规凝血参数相关性,比较肾癌不同病理类型、不同病理分期TEG参数之间的差异。结果:与肾良性疾病组比较,肾癌组TEG的R值和K值明显缩短(P<0.01),Angel、MA和CI值明显增宽(P<0.01),常规凝血功能PT、FIB有显著升高(P<0.01),PTA值下降(P<0.05),INR、DD值上升(P<0.05),APTT、TT指标差异均无统计学意义(P>0.05)。肾癌组Ⅳ期与Ⅰ期、Ⅱ期、Ⅲ期比较,TEG参数差异更有统计学意义(P<0.05);有淋巴结转移(N 0)与无淋巴转移(N 1)的肾癌患者相比较,TEG参数中K值、Angel值、MA值和CI值差异具有统计学意义(P<0.05);肾癌患者TEG某些参数与常规凝血检查参数之间存在相关性。结论:肾癌患者围手术期血液易处于高凝状态,而且高凝状态与晚期病情呈正相关。用TEG来评估肾癌患者围手术期的凝血状态更准确,与常规凝血实验检测具有互补作用。

Objective:Application of thrombelastogram(TEG)and routine coagulation tests to estimate perioperative coagulation status in patients with renal cancer and explore the clinical value of TEG.And to study the correlation of major indicators between TEG and coagulation function.Methods:A total of 142 patients who experienced renal surgery in our hospital from January 2016 to March 2018 were selected.First,patients were divided into a kidney cancer group(97 cases)and a renal benign disease group(45 cases)according to postoperative pathological results.To evaluate the difference of coagulation function in perioperative period between two groups of patients by TEG and conventional coagulation test,and to assess the clinical value of them.Second,the kidney cancer group was analyzed separately to compare the correlation between TEG and routine blood coagulation parameters in patients with renal cell carcinoma,and to find the relationship between TEG parameters of different pathological types and different pathological stages of renal cell carcinoma.Results:Compared with the benign renal disease group,R and K value of TEG in renal cell carcinoma group were significantly shorter(P<0.01),Angel,MA,and CI values were significantly wider(P<0.01).PT and FIB values were significantly increased in routine coagulation(P<0.01).PTA values were decreased(P<0.05).INR and DD values were increased(P<0.05).The differences in APTT and TT values were not statistically significant(P>0.05).Compared with stageⅠ,stageⅡ,and stageⅢ,there was a statistically significant difference in TEG parameters in stageⅣkidney cancer(P<0.05).Compared with patients with lymph node metastasis(N 0)and non-lymphatic metastasis(N 1),K,Angel,MA and CI value in TEG parameters were statistically significant(P<0.05).There is a correlation between certain parameters of TEG and conventional coagulation parameters in kidney cancer patients.Conclusion:Blood of perioperative patients with kidney cancer is prone to hypercoagulability,and hypercoagulability is positively related to late-stage disease.TEG is more accurate in assessing the perioperative coagulation status of kidney cancer patients and complementary to routine coagulation tests.