胃肠道恶性肿瘤病人围手术期静脉血栓栓塞症诊治分析

Diagnosis and treatment of perioperative venous thromboembolism in patients with malignant gastrointestinal tumor

目的分析胃肠道恶性肿瘤病人围手术期静脉血栓栓塞症(venous thromboembolism,VTE)特点,为临床防治提供参考。方法选取2021年1月至2021年8月华中科技大学同济医学院附属协和医院胃肠道恶性肿瘤手术病人为研究对象,收集其相关临床资料。所有病人于手术前后行下肢静脉超声检查明确有无下肢深静脉血栓形成(deep vein thrombosis,DVT)。肺血栓栓塞症(pulmonary embolism,PE)病人经肺动脉CT血管造影检查确诊。结果共纳入394例胃肠道恶性肿瘤手术病人,男性271例,女性123例,年龄(59.0±11.3)岁。其中合并有高血压病史者117例、糖尿病36例、冠心病29例。394例病人中胃癌145例,结肠癌129例,直肠癌120例。394例病人中,术后共发现VTE病人129例,发生率为32.7%。127例下肢DVT病人中,117例(92.1%)为无症状性下肢DVT,其中肌间静脉血栓106例(106/127,83.4%)。非DVT组与无症状DVT组比较,年龄、术前D-二聚体、术后第1天D-二聚体、术后住院时间差异均具有统计学意义(均P<0.05)。结论胃肠道恶性肿瘤病人术后下肢DVT发生率较高,绝大多数无明显临床症状;胃肠道恶性肿瘤病人术后常规行下肢静脉超声检查对早期发现下肢DVT有着重要意义。

Objective To explore the characteristics of perioperative venous thromboembolism(VTE)in patients with malignant gastrointestinal tumor(MGT)to provide rationales for its clinical preventions and treatments.Methods From January 2021 to August,clinical data were reviewed for 394 MGT patients.Both preoperative and postoperative ultrasonographies of lower-extremity vein were performed to determine the presence of deep venous thrombosis(DVT).And pulmonary thromboembolism(PE)was diagnosed by pulmonary artery computed tomography(CT)angiography.Results There were 271 males and 123 females with an age range of(59.0±11.3)years.There was a previous history of hypertension(n=117),diabetes(n=36)and coronary heart disease(n=29).And there were gastric cancer(n=145),colon cancer(n=129)and rectal cancer(n=120).And VTE(n=129)occurred with an incidence of 32.7%.Among 127 patients with lower-extremity DVT,117 cases were asymptomatic accounting for 92.1%(117/127)and muscular calf vein thrombosis occurred in 106 patients(106/127,83.4%).Significant inter-group differences existed in age,preoperative D-dimer,D-dimer at Day 1 post-operation and postoperative hospital stay(P<0.05).Conclusion The incidence of postoperative lower-extremity DVT is high in MGT patients.Most cases lack overt clinical symptoms.Postoperative routine lower-extremity vein ultrasonography is vital for an early detection of DVT in MGT patients.