膀胱癌电切术后凝血功能状态与术后静脉血栓栓塞症及局部淋巴结转移的相关性

Correlation of coagulation function with postoperative venous thromboembolism and local lymph node metastasis after electroresection for bladder cancer

目的分析膀胱癌电切术后凝血功能指标变化及其与术后静脉血栓栓塞症(VTE)、局部淋巴结转移相关性。方法选取2020年1月—2022年10月河南科技大学第一附属医院新区医院泌尿外科收治膀胱癌患者145例为研究对象,统计腹腔镜下根治性膀胱癌电切术后3个月内VTE发生(非VTE组117组,VTE组28例)、局部淋巴结转移情况,并比较其术后3 d凝血功能指标[D-二聚体(D-D)、血小板计数(PLT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、活化部分凝血活酶时间(APTT)]。Logistic回归分析术后VTE发生的影响因素,受试者工作特征曲线(ROC)分析凝血功能指标对术后VTE发生的预测价值。Spearman相关系数分析术后凝血功能指标与局部淋巴结转移相关性。结果膀胱癌患者145例VTE发生率为19.31%(28/145),局部淋巴结转移发生率为15.17%(22/145);VTE发生者年龄、糖尿病发生率、手术时间与术后D-D、PLT、Fib、APTT显著高于未发生者[χ^(2)(t)/P=4.390/<0.001、8.332/0.004、6.029/<0.001、8.146/<0.001、3.350/0.001、6.265/<0.001、2.921/0.004];局部淋巴结转移发生者术后D-D、PLT、Fib、APTT高于未发生者(t=10.664、4.300、7.827、5.114,P均<0.001),其与局部淋巴结转移呈正相关(r=0.412、0.371、0.386、0.403,P均<0.001),而TT、PT与局部淋巴结转移无相关性(r/P=0.191/0.413、0.201/0.365)。合并糖尿病、手术时间与术后D-D、PLT、Fib、APTT升高为术后VTE发生的独立危险因素[OR(95%CI)=2.879(1.267~6.543)、3.155(1.381~7.209)、4.565(2.013~10.354)、3.653(1.576~8.467)、3.926(1.652~9.331)、3.396(1.469~7.853)];术后D-D、PLT、Fib、APTT联合预测术后VTE发生的AUC大于各指标单独预测(Z/P=2.945/0.003、1.994/0.046、2.011/0.042、3.186/0.001)。结论膀胱癌电切术后凝血功能异常,术后D-D、PLT、Fib、APTT与VTE及局部淋巴结转移密切相关,联合检测其水平对术后VTE发生具有一定预测价值。

Objective To analyze the changes of coagulation function after resection of bladder cancer and its correlation with postoperative venous thromboembolism(VTE)and local lymph node metastasis.Methods From January 2020 to October 2022,145 patients with bladder cancer who were admitted to the Department of Urology of the New Area Hospital of the First Affiliated Hospital of Henan University of Science and Technology were selected as the study subjects.The incidence of VTE(117 patients in the non VTE group,28 patients in the VTE group)and local lymph node metastasis within 3 months after laparoscopic radical resection of bladder cancer were counted,and the coagulation function indicators(D-dimer(D-D),platelet count(PLT),thrombin time(TT)Prothrombin time(PT),fibrinogen(FIB),activated partial thromboplastin time(APTT).Logistic regression analysis is used to analyze the influencing factors of postoperative VTE,and the predictive value of coagulation function indicators on postoperative VTE occurrence is analyzed using the receiver operating characteristic curve(ROC).Spearman correlation coefficient analysis showed the correlation between postoperative coagulation function indicators and local lymph node metastasis.Results The incidence of VTE in 145 patients with bladder cancer was 19.31%(28/145),and the incidence of local lymph node metastasis was 15.17%(22/145).Age,incidence of diabetes,operation time and postoperative D-D,PLT,Fib,APTT of VTE patients were significantly higher than those of non VTE patients[χ^(2)(t)/P=4.390/<0.001,8.332/0.004,6.029/<0.001,8.146/<0.001,3.350/0.001,6.265/<0.001,2.921/0.004.The postoperative D-D,PLT,FIB,and APTT levels in patients with local lymph node metastasis were higher than those without(t=10.664,4.300,7.827,5.114,P<0.001),and they were positively correlated with local lymph node metastasis(r=0.412,0.371,0.386,0.403,P<0.001),while TT and PT were not correlated with local lymph node metastasis(r/P=0.191/0.413,0.201/0.365).Diabetes,operation time,and postoperative elevation of D-D,PLT,Fib,APTT were independent risk factors for VTE[OR(95%CI)=2.879(1.267-6.543),3.155(1.381-7.209),4.565(2.013-10.354),3.653(1.576-8.467),3.926(1.652-9.331),3.396(1.469-7.853)].The AUC predicted by the combination of postoperative D-D,PLT,FIB,and APTT for postoperative VTE was greater than that predicted by each indicator alone(Z/P=2.945/0.003,1.994/0.046,2.011/0.042,3.186/0.001).Conclusion The coagulation function of patients with bladder cancer after electric resection is abnormal.Postoperative D-D,PLT,Fib,APTT are closely related to VTE and local lymph node metastasis.Joint detection of their levels has certain predictive value for the occurrence of VTE after operation.