恶性肿瘤手术后静脉血栓栓塞症患者临床特点及预后分析  

Clinical characteristics and outcomes of malignancy surgical patients with venous thromboembolism

作　　者：金金[1] 谭政[1] 乔力松[1] 杨鹤[1] 张丽[1] 王艳[1] 杨菁菁[1] 方保民[1] 许小毛[1] Jin Jin;Tan Zheng;Qiao Lisong;Yang He;Zhang Li;Wang Yan;Yang Jingjing;Fang Baomin;Xu Xiaomao(Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing 100730, China)

机构地区：[1]北京医院国家老年医学中心呼吸与危重症医学科,100730

出　　处：《国际呼吸杂志》2019年第3期201-206,共6页International Journal of Respiration

基　　金：国家精准医学研究课题(2016YFC0905602);国家“十二五”科技支撑课题(2011BAI11B17).

摘　　要：目的分析恶性肿瘤手术后静脉血栓栓塞症(VTE)患者的发病情况、临床特点及预后。方法选择北京医院2003年1月至2013年4月间,因恶性肿瘤接受开放性手术,并于手术后90d内并发VTE,且具有完整临床资料的68例患者进行回顾性分析。结果北京医院10年间共收治恶性肿瘤手术患者10967例,术后90d内发生VTE68例,发病率为0.62%,主要发生于妇科肿瘤、肺癌、泌尿系统肿瘤、消化道肿瘤、乳腺癌和血液系统肿瘤患者中,其中妇科肿瘤和肺癌术后VTE发病率最高(分别为1.03%和0.95%),明显高于其他类型肿瘤(P值均<0.05)。68例患者中男31例,女37例,年龄(63.94±10.50)岁,合并心血管疾病者29例(42.65%);术后卧床制动>3d共34例(50.00%),VTE发病距离手术时间为(33±30)d,手术麻醉时间为(172.75±104.71)min,术后病理提示中低分化癌者40例(58.82%),Caprini评分≥5分者51例(75.00%)。老年组36例(52.94%),非老年组32例(47.06%)。老年组体质量指数较非老年组低(t=-2.052,P=0.044);老年组Caprini评分明显高于非老年组(t=2.613,P=0.011);老年组D-二聚体明显高于非老年组(Z=-1.976,P=0.048)。老年组晚发VTE(术后5~12周内发病)发病率明显高于非老年组(χ^2=8.438,P=0.004)。3例致死性肺血栓栓塞症均发生在老年组,均为晚发VTE,均未给予预防措施。结论北京医院10年间恶性肿瘤手术后VTE的发病率为0.62%,各种肿瘤中以妇科肿瘤和肺癌术后VTE发病率最高。老年人恶性肿瘤手术后VTE应延长观察时间至12周,老年致死性肺栓塞可发生于术后5~12周。Objective To explore the incidence, clinical characteristic and outcome of malignancy surgical patients with venous thromboembolism (VTE). Methods The clinical data of sixty-eight malignancy surgical cases who suffered from VTE during the postoperative 90 days and hospitalized from January 2003 to April 2013 at Beijing Hospital were reviewed. Results There were 10 967 cases of malignancy surgeries during the observed ten years and 68 cases suffered from VTE during the postoperative 90 days (incidence was 0.62%), including gynecological malignancy, lung cancer, urinary system malignancy, digestive tract malignancy, breast cancer and hematological malignancy.Gynecological malignancy and lung cancer had the highest VTE incidence (1.03% and 0.95% respectively), there was significant difference with the other types (all P<0.05). Among 68 patients, 31 cases of male and 37 cases of female were involved, with an average age of (63.94±10.50) years old, average postoperative time of (33±30) days, average anesthesia duration of (172.75±104.71) minutes, including 29 cases (42.65%) with cardiovascular diseases, 34 cases (50.00%) immobilized more than three days after operation, 40 cases (58.82%) with middle and low differentiation carcinoma in pathology, and 51 cases (75.00%) with Caprini score equal or greater than five.There were 36 cases in elderly group (≥65 years old)and 32 cases in non-elderly group (<65 years old). Compared with non-elderly group, the body mass index was lower (t=-2.052, P=0.044), Caprini score (t=2.613, P=0.011), D-dimer (Z=-1.976, P=0.048), and incidence of late-onset VTE (occurring in postoperative 5-12 weeks)(χ2=8.438, P=0.004) were higher in elderly group.All the three cases of fetal pulmonary thromboembolism were late-onset VTE patients in elderly group without any prophylactic measures. Conclusions The incidence of VTE in malignancy surgery patients during the postoperative 90 days is 0.62%.Gynecological malignancy and lung cancer are the most common types.The observation time for the VTE

关 键 词：肿瘤 手术 静脉血栓栓塞 静脉血栓形成 

分 类 号：R730.56[医药卫生—肿瘤]