子宫内膜癌围手术期症状性静脉血栓栓塞症23例临床特征分析

The clinical characteristics of 23 cases with perioperative symptomatic venous thromboembolism in endometrial carcinoma

目的探讨子宫内膜癌患者围手术期症状性静脉血栓栓塞症(VTE)的临床特征、诊治及预防。方法回顾性分析2004年1月至2012年12月北京大学人民医院妇科住院的23例子宫内膜癌围手术期发生的症状性VTE患者的临床资料。结果 23例患者的平均年龄(58.1±8.3)岁,其中1例(4.3%)肺栓塞(PE)合并深静脉血栓(DVT),22例(95.7%)下肢深静脉血栓,均出现患肢肿胀或疼痛;21例(91.3%)DVT均发生在术后,其中19例(90.5%)发生于术后20天内。DVT均累及下肢静脉,其中单独累及肌间静脉14例(65.2%)。1例PE以放置下腔静脉滤器治疗;12例(54.5%)以低分子肝素皮下注射继以华法林口服治疗。术后平均随访(37.7±23.4)个月,5例(21.7%)患者死亡,其中4例死于肿瘤,1例死于脑梗,无VTE所致的死亡。结论子宫内膜癌围手术期症状性VTE主要发生在术后20天内,应积极预防。对术后出现肢体肿胀或者疼痛的患者应警惕血栓发生。

Objective To summarize the clinical characteristics, diagnosis and treatments, and preventions of perioperative symptomatic venous thromboembolism(VTE) in patients with endometrial carcinoma. Methods The clinical data of 23 patients with endometrial carcinoma who occurred symptomatic VTE during the perioperative period from January 2004 to December 2012 were retrospectively analyzed in Peking University People’s Hospital. Results The mean age was(58.1±8.3)years. One case(4.3%) of PE complicated with deep venous thrombosis(DVT), 21 cases(91.3%) perioperative VTE occurred in postoperative patients, of which 90.5% occurred within 20 days after operation, and 22 cases(95.7%) of them were DVT. DVT involved all the lower extremity veins, which accounted for 65.2% of the cases involving the calf muscular veins alone. As for the treatments, PE was treated by the placement of inferior vena cava filter in one case, 12 cases treated by the subcutaneous injection of low molecular weight heparin followed by oral warfarin. After an average follow-up time of(37.7±23.4) months, 5 patients(21.7%) died, of which 4 died of tumor and 1 died of cerebral infarction, without VTE-induced death. Conclusions Perioperative VTE of endometrial carcinoma mainly occurs after 20 days operation, so we should focus on the prevention of postoperative VTE. It should be alert to the occurrence of postoperative thrombosis of the patients with limbs swelling or pain.