妇科围手术期并发静脉血栓栓塞症38例分析

Analysis of thirty-eight cases of gynecological perioperative venous thromboembolism

目的探讨妇科肿瘤围手术期发生静脉血栓栓塞症(VTE)的高危因素及预防措施。方法回顾性分析2018年1月—2021年5月于中山市人民医院妇科收治的围手术期VTE患者38例(9例术前发生血栓、29例术后发生血栓)的临床特征、诊疗过程,并根据高危因素提出针对性的预防措施。结果9例术前血栓的患者,其中恶性肿瘤、血浆D-二聚体阳性(>500 mg/L)与对照组比较差异有统计学意义(P<0.05),而年龄、BMI、合并内科疾病与对照组比较,差异无统计学意义(P>0.05);29例术后血栓的患者,BMI>25 kg/m^(2)、恶性肿瘤、合并内科疾病、手术时间大于3小时、术后使用止血药物与对照组比较差异有统计学意义(P<0.05);而年龄与手术方式与对照组比较差异无统计学意义(P>0.05)。结论恶性肿瘤、血浆-D二聚体阳性、手术时间大于3小时、术后使用止血药物均为妇科围手术期血栓发生的高危因素,针对上述高危因素积极预防可显著降低VTE的发生。

Objective To study the high-risk factors and preventive measures of venous thromboembolism in gynecological periopreative surgery.Methods The clinical characteristics and the diagnosis and treatment of thirty-eight cases with perioperative deep venous thrombosis(nine cases with preoperative deep venous thrombosis and twenty-nine cases with postoperative deep venous thrombosis)in the department of gynecology of Zhongshan People’s Hospital were analyzed retrospectively.Targeted preventive measures were put forward according to high risk factors.Results Compared with the control group,there were significance differences in malignant tumor,positive D-dimer(>500 mg/L)in nine cases with preoperative thrombosis(P<0.05),but no significance differences in age,body mass index(BMI),complicated with internal diseases(P>0.05).BMI>25,malignant tumor,complicated with internal diseases,operation time more than 3 hours,postoperative usage of hemostatics in twenty-nine cases with postoperative deep venous thrombosis had statistical significance compared with the control group(P<0.05).But age and surgery method had no statistical significance(P>0.05)between the two groups.Conclusions Malignant tumor,positive D-dimer(>500 mg/L),operation time more than 3 hours,postoperative usage of hemostatics were the high-risk factors in gynecological periopreative surgery,active prevention against these high-risk factors can significantly reduce the incidence of venous thromboembolism.