胰腺癌术后发生静脉血栓栓塞症的危险因素与对策分析

Risk factors and countermeasures of venous thromboembolism after pancreatic cancer surgery

目的 探讨胰腺癌术后发生静脉血栓栓塞症(VTE)的危险因素及对策。方法 收集2021年1月至2023年1月于空军军医大学第一附属医院(西京医院)进行手术治疗的胰腺癌患者的临床资料,将术后7 d内发生VTE的患者作为VTE组(n=33),采用倾向评分匹配法,根据VTE组患者的性别、年龄按1:2的比例将术后7 d内未发生VTE的患者作为NVTE组(n=66)。分析胰腺癌术后发生VTE的危险因素,并评估各危险因素对胰腺癌术后发生VTE的预测价值。结果 两组患者的组织因子水平、术后第1天D-二聚体水平、血管重建方式、分化程度比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,组织因子水平较高、术后第1天D-二聚体水平较高、采用同种异体血管置换、低分化程度均为胰腺癌术后发生VTE的独立危险因素(P﹤0.05)。组织因子水平≥9.68 pg/ml、术后第1天D-二聚体水平≥2.22 mg/L、采用同种异体血管置换进行血管重建、低分化程度均为胰腺癌术后发生VTE的危险因素模型,受试者工作特征(ROC)曲线分析结果显示,组织因子水平、术后第1天D-二聚体水平对于胰腺癌术后发生VTE具有中等预测价值(P﹤0.05);上述4个指标联合构建的模型对于胰腺癌术后发生VTE具有较高的预测价值(P﹤0.05)。结论 组织因子水平较高、术后第1天D-二聚体水平较高、采用同种异体血管置换进行血管重建、低分化程度均为胰腺癌术后发生VTE的危险因素,据此针对高危患者给予有针对性地防治可有效提高手术安全性,降低术后发生VTE的风险。

Objective To analyze the risk factors and countermeasures of venous thromboembolism(VTE)after pancreatic cancer surgery.Method The clinical data of patients with pancreatic cancer who received surgical treatment in the First Affiliated Hospital of the Air Force Medical University(Xijing Hospital)from January 2021 to January 2023 were collected.The patients who had VTE within 7 days after surgery were regarded as the VTE group(n=33).By using the propensity score matching method,the patients who had no VTE within 7 days after surgery were regarded as the NVTE group(n=66)according to the 1:2 ratio of gender and age.The risk factors of VTE after pancreatic cancer surgery was analyzed and the predictive value of each risk factor level for VTE after pancreatic cancer surgery were evaluated.Result There were statistically significant differences in tissue factor level,D-dimer level 1 day after surgery,vascular remodeling and differentiation degree between two groups(P<0.05).Multivariate analysis showed that high tissue factor level,high D-dimer level 1 day after surgery,allogeneic vascular replacement and low differentiation were risk factors for VTE after pancreatic cancer surgery(P<0.05).Tissue factor level≥9.68 pg/ml,D-dimer level 1 day after surgery≥2.22 mg/L,allogeneic vascular replacement,and low differentiation are the risk factors model for the VTE after pancreatic cancer surgery.The receiver operating characteristic(ROC)curve showed that the tissue factor and D-dimer level 1 day after surgery have medium independent predictive value for the VTE after pancreatic cancer surgery(P<0.05).The combined model of the above four indicators had a high predictive value for VTE formation after pancreatic cancer surgery(P<0.05).Conclusion High tissue factor level,high D-dimer level 1 day after surgery,vascular reconstruction with allogeneic vascular replacement,and low differentiation are risk factors for postoperative venous thrombosis of pancreatic cancer.Targeted prevention and treatment can effectively improve the safety of surgery and reduce the risk of postoperative venous thrombosis.