泌尿系肿瘤患者围手术期并发静脉血栓栓塞症的发生率和相关危险因素

Incidence and risk factors of perioperative venous thromboembolism in patients with urinary tumor

目的研究泌尿系肿瘤患者围手术期并发静脉血栓栓塞症(VTE)的发生率和相关危险因素。方法选取2016年6月至2019年6月本院行手术治疗的泌尿系肿瘤患者97例,根据患者是否发生VTE将其分为VTE组(13例)和NVTE组(84例)。统计围手术期发生VTE的发生率,并分析影响VTE发生的独立危险因素。结果围手术期间,共13例确诊为VTE。单因素分析提示,两组患者的VTE史(4例vs.7例)、盆腔淋巴结清扫(10例vs.26例)、术中抗凝措施(2例vs.44例)、留置中心静脉导管(9例vs.13例)及术后卧床时间(>3 d:9例vs.15例)比较,差异存在统计学意义(P<0.05),两组性别、年龄、体重指数(BMI)、吸烟史高血压史等情况比较,差异无统计学意义(P>0.05)。Logistic回归分析提示,留置中心静脉导管、盆腔淋巴结清扫是泌尿系肿瘤患者围手术期发生VTE的独立危险因素,而术中抗凝措施是围手术期发生VTE的保护因素。结论泌尿系肿瘤患者在围手术期发生VTE的发生率较高,尽量避免留置中心静脉导管或缩短导管留置时间,在保障手术效果的基础上缩小手术范围,并在术中合理应用抗凝措施均能在一-定程度.上减少围手术期VTE的发生风险。

Objective To investigate the incidence rate and risk factors of perioperative ve-nous thromboembolism(VTE)in patients with urinary tumor.Methods Between June 2016 and June 2019,97 patients with urinary tract tumors who underwent surgical treatment in our hospital were enrolled,the incidence of perioperative VTE was recorded,and the independent risk factors affecting the occurrence of VTE were analyzed.Results During the perioperative period,13 of the 97 patients with urological tumors were diagnosed with VTE.Univariate analysis revealed signifcant differences in VTE history,pelvic lymph node dissection,intraoperative anticoagulation measures,central venous catheter indwelling and postoperative bed rest time between VTE group and NVTE group(P<0.05),while no significant difference was found in gender,age,BMI,smoking history,hypertension history(P>0.05).Logistie regression analysis showed that indwelling central venous catheter and pelvie lymphadenectomy were independent risk factors of VTE in urological tumor patients,while anticoagu-lant measures were protective factors.Conclusions Due to the high ncidence of perioperative VTE in the surgical treatment of urinary tract tumors,the corresponding preiventive measures are of vital im-portance,which includes avoidance of central venous catheter indwelling or the shortening of catheter indwelling time,the narrowing of operation area,and the reasonable application of anticoagulation duri ng t he operation.