65例头颈部恶性肿瘤根治术后急性肺血栓栓塞症临床分析

Clinical analysis of 65 patients with acute pulmonary thromboembolism after radical resection of malignant tumors of head and neck

目的:探讨头颈部恶性肿瘤患者术后急性肺血栓栓塞症(pulmonary thromboembolism,PTE)的临床特点与相关危险因素。方法:前瞻性纳入接受头颈部恶性肿瘤根治术的患者65例,记录患者基本特征、手术时间、卧床时间、凝血功能、深静脉血栓及PTE发生情况和处理方法等相关资料,探讨以上指标与头颈部恶性肿瘤根治术后PTE发生情况的相关性。采用SPSS 25.0软件包对数据进行统计学分析。结果:经肺动脉CT血管造影术(CT angiography,CTA)等相关检查,65例患者中,18例(27.7%)确诊为PTE,其中3例(4.6%)具有明显临床表现。呼吸困难、胸痛、咳嗽为PTE患者的主要临床症状,心动过速、血氧饱和度降低、呼吸频率加快、呼吸啰音是PTE患者最常见的体征。术后最高D二聚体与卧床时间过长,是头颈部恶性肿瘤根治术后发生PTE的重要危险因素。结论:头颈部恶性肿瘤根治术后围术期急性PTE发生率较高,临床表现及体征缺乏典型性。对PTE患者进行早期诊断和早期干预,是改善预后的关键。

PURPOSE:To investigate the clinical characteristics and related risk factors of postoperative acute pulmonary thromboembolism(PTE)in patients with head and neck cancer.METHODS:Sixty-five patients who underwent radical surgery for head and neck malignancies were prospectively included,and data related to patients'basic characteristics,operation time,bed rest,coagulation function,deep vein thrombosis and the occurrence and management of PTE were recorded to investigate the correlation between the above indicators and the occurrence of PTE after radical surgery for head and neck malignancies.SPSS 25.0 software package was used for data analysis.RESULTS:Among 65 patients,18(27.7%)were diagnosed with PTE by pulmonary CTA and other related examinations,3(4.6%)had obvious clinical symptoms of PTE.Dyspnea,chest pain,and cough were the main clinical symptoms of PTE patients,and tachycardia,decreased oxygen saturation,increased respiratory rate and respiratory rales were the most common signs in PTE patients.The highest postoperative D-dimer and prolonged bed rest are important risk factors for the occurrence of PTE after radical surgery for head and neck malignancy.CONCLUSIONS:The incidence of acute PTE in the perioperative period after radical head and neck malignancy is high,with clinical manifestations and signs lacking specificity.Early diagnosis and early intervention for patients with PTE are important steps in improving prognosis.