延长围手术期使用低分子肝素对结肠癌根治术后无病生存率的影响

Effect of prolonging perioperative use of low molecular weight heparin on diseasefree survival rate after radical resection of colon cancer

目的探讨延长围手术期使用低分子肝素对结肠癌手术切除后无进展生存率(progression free survival,PFS)的影响。方法选取2015年1月至2017年12月在玉环市人民医院接受手术治疗的214例Ⅰ期和Ⅱ期结肠癌患者作为研究对象,采用随机数字表法将患者分为A组(n=107)和B组(n=107)。A组于术前12h至术后7d皮下注射低分子肝素2500U,1次/d。B组于术前12h至术后28d皮下注射低分子肝素2500U,1次/d。比较两组患者PFS、手术相关指标、术前后凝血功能指标[凝血酶原时间(prothrombin time,PT)、部分活化凝血酶原时间(partially activated prothrombin time,APTT)、纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-dimer,D-D)]和术后下肢深静脉血栓(deep venous thrombosis,DVT)发生率。结果B组中位PFS高于A组,差异有统计学意义(P<0.05)。两组患者手术时间、术中出血量、排气时间、住院时间等比较,差异均无统计学意义(P>0.05)。术后1d和3d两组患者PT、APTT均低于术前,FIB和D-D高于术前,差异均有统计学意义(P<0.05);术后3d两组患者PT和APTT均高于术后1d,FIB和D-D均低于术后1d,差异均有统计学意义(P<0.05)。两组住院期间、出院后和合计症状性DVT比较,差异均无统计学意义(P>0.05);B组患者无症状性DVT发生率低于A组,差异有统计学意义(P<0.05)。结论结肠癌根治术患者术后延长LMWH使用时间可减少无症状DVT发生和提高PFS,值得临床进一步研究探讨。

Objective To study the effect of prolonged perioperative use of low molecular weight heparin on progression free survival(PFS)after resection of colon cancer.Methods A total of 214 patients with stageⅠand stageⅡcolon cancer who underwent surgery in the People’s Hospital of Yuhuan from January 2015 to December 2017 were selected and divided into group A(n=107)and group B(n=107)according to random number table method.PFS,the incidence of postoperative deep venous thrombosis(DVT)and the related indexes of operation,preoperative and postoperative coagulation function[prothrombin time(PT),partially activated prothrombin time(APTT),fibrinogen(FIB)and D-dimer(D-D)]were compared in the two groups.Results The median PFS in group B was higher than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in operation time,intraoperative bleeding,exhaust time and hospitalization time between the two groups(P>0.05).1 day and 3 days after operation,PT and APTT in two groups were lower than those before operation,FIB and D-D were higher than those before operation,and the differences were statistically significant(P<0.05).3 days after operation,PT and APTT in the two groups were higher than those in 1 day after operation,and FIB and D-D were lower than those in 1 day after operation.The differences were statistically significant(P<0.05).There was no significant difference between the two groups during hospitalization,after discharge and the total symptomatic DVT(P>0.05).The incidence of asymptomatic DVT in group B was significantly lower than that in group A(P<0.05).Conclusion Prolonging the use of low molecular weight heparin after radical resection of colon cancer can reduce the occurrence of asymptomatic DVT and improve PFS,which is worthy of further clinical research.