胸腺恶性肿瘤术后静脉血栓栓塞症的影响因素分析

Analysis of Influencing Factors for Postoperative Venous Thromboembolism of Thymic Malignancies

背景与目的胸外科术后静脉血栓栓塞症(venous thromboembolism, VTE)的发生率高,本研究旨在分析胸腺恶性肿瘤术后VTE的发生率及相关危险因素。方法本研究为单中心研究。收集2017年12月-2021年2月在首都医科大学附属北京同仁医院胸外科接受胸腺恶性肿瘤切除手术治疗的患者资料。除术前常规检查以外,所有患者于手术前后行下肢多普勒超声以明确有无下肢深静脉血栓(deep venous thrombosis, DVT)。患者术前术后均未接受任何形式抗凝治疗。全部患者接受改良Caprini风险评估。根据术后是否发生VTE将患者分为VTE组和对照组,比较两组间的临床资料,统计术后VTE的发生时间、可能的高危因素等。结果共纳入169例接受胸腺恶性肿瘤切除手术的患者,男性94例,女性75例,年龄范围:22岁-76岁。本研究共95例患者选择胸腔镜手术,74例选择正中劈胸骨手术。全组共21例发生VTE,VTE的总发生率为12.4%。诊断VTE的中位时间为术后4 d(2 d-15 d)。根据改良Caprini评分分组,低危组(≤4分)发生率为0%(0/7),中危组(5分-8分)为7.0%(8/115),高危组(≥9分)为27.7%(13/47)(Z=1.670, P=0.008)。单因素分析结果显示VTE组年龄、手术方式、手术时间、留置中心静脉导管、术后卧床时间超过72 h均与对照组有显著差异(P<0.05)。多因素分析结果显示年龄≥60岁、手术方式、手术时长是胸腺恶性肿瘤术后发生VTE的独立危险因素。结论年龄≥60岁、手术方式、手术时长是胸腺恶性肿瘤患者术后发生VTE的独立危险因素,改良Caprini评分可有效筛选高危患者。

Background and objective The previous study has indicated that the incidence of venous thromboembolism(VTE) after thoracic surgery is high. The purpose of this study was to analyze the incidence and risk factors of postoperative VTE in thymic malignancy patients. Methods This was a single-center study. Patients undergoing resection for thymic malignancy between December 2017 and February 2021 in Department of Thoracic Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled in this study. In addition to the routine examination, all patients were screened for deep venous thrombosis(DVT) by using noninvasive duplex lower extremity ultrasound before and after surgery. Patients did not receive any prophylactic anticoagulant therapy before and after surgery. All patients received modified caprini risk assessment. According to whether VTE occurred after operation, patients were divided into VTE group and control group. The clinical data of the two groups were compared. The occurrence time and possible high risk factors of VTE after operation were analyzed. Results A total of 169 patients with thymic malignant tumor were enrolled, including 94 males and 75 females, aging from 22 to 76 years. A total of 95 patients underwent thoracoscopic surgery and 74 patients underwent median sternotomy. The total incidence of VTE was 12.4%. The median time for diagnosis of VTE was 4 days(2 days-15 days) after operation. According to the modified caprini score, the incidence of VTE in low risk patients(Caprini score≤4 points), moderate risk patients(Caprini score 5 to 8 points) and high risk patients(Caprini score≥9 points) were 0%(0/7), 7.0%(8/115) and 27.7%(13/47), respectively(Z=1.670, P=0.008). Univariate analysis showed that there were significant differences between VTE group and control group in age, operation method, operation time, indwelling central venous catheter, postoperative bed rest time more than 72 hours(P<0.05). Multivariate analysis showed that over 60 years old, operation method and operation time were independent risk factors for VTE after resection for thymic malignancies. Conclusion Over 60 years old, operation method and operation time are independent risk factors for VTE. Modified caprini assessment can effectively screen high-risk patients.