泌尿外科盆腔肿瘤大手术后发生静脉血栓栓塞症的临床分析及防治体会

发布时间：2018-01-02 10:34

  本文关键词：泌尿外科盆腔肿瘤大手术后发生静脉血栓栓塞症的临床分析及防治体会　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 泌尿系统肿瘤手术 静脉血栓栓塞症 膀胱癌 前列腺癌

【摘要】：目的:静脉血栓栓塞症(venous thromboembolism,VTE)是外科手术术后常见的严重并发症之一,新发VTE在30天内的死亡率很高。而前列腺癌和膀胱癌是主要的泌尿外科盆腔肿瘤,其发病率在我国也逐年升高。本文旨在通过收集我院泌尿外科盆腔肿瘤大手术(全膀胱切除术、前列腺癌根治术)患者的临床资料,了解术后VTE的发生率及影响因素,并总结围手术期VTE的防治体会。方法:回顾性分析2010年01月至2016年12月期间在我院泌尿外科住院,确诊为膀胱恶性肿瘤或前列腺恶性肿瘤并行全膀胱切除术或前列腺癌根治术患者的临床资料。了解术后VTE的发生率及围手术期采用Capirin静脉血栓评估模型及相应预防措施前后VTE的发生率变化。统计分析患者及手术相关影响因素对术后发生VTE的影响。同时,检索VTE相关防治指南及文献总结泌尿外科VTE的防治体会。结果:根据本研究的纳入标准及排除标准,入组共316例患者。其中全膀胱切除术180例,平均年龄68.4±11.6(38-91)岁;平均BMI 24.0±3.1(19.0-32.1)Kg/m2。其中腹腔镜手术124例(68.9%),开放手术56例(31.1%)。平均手术时间312.6±97.1(140-600)min;平均手术出血592.4±492.8(50-2500)ml;围手术期输血56例(31.1%);术中伴清扫盆腔淋巴结157例(87.2%)。前列腺癌根治性手术136例,平均年龄71.0±7.2(52-86)岁;平均BMI 25.2±2.8(20.6-34.1)Kg/m2。其中腹腔镜手术110例(80.9%),开放手术26例(19.1%)。平均手术时间216.6±76.4(60-420);平均手术出血500.7±636.6(30-4000)ml;围手术期输血23例(16.9%);术中伴清扫盆腔淋巴结57例(41.9%)。术后30天内新发有症状的VTE 6例,总发生率为1.9%;其中发生下肢深静脉血栓6例(1.9%),肺栓塞1例(0.3%),1例患者同时合并下肢深静脉血栓和肺栓塞,平均发生于术后的7.7±5.6(1-16)天;其中全膀胱切除术VTE发生率为2.2%(4/180),前列腺癌根治术VTE发生率为1.5%(2/136)。本组研究中,术中伴盆腔淋巴结清扫增加了术后VTE的发生,围手术期输血、肿瘤分期、手术时间(4h)等对术后发生VTE的影响无统计学意义(P0.05)。将Caprini静脉血栓评估模型用于泌尿外科盆腔肿瘤大手术围手术期VTE评估及预防前后对比,减少了术后VTE的发生(P0.05,差异有统计学意义)。结论:泌尿外科盆腔肿瘤大手术后30天内新发有症状VTE的发生率为1.9%。本研究中,全膀胱切除术后VTE发生率较前列腺癌根治术高(2.2%VS 1.5%),术中伴盆腔淋巴结清扫与术后VTE的发生明显相关。Caprini静脉血栓评估模型用于泌尿外科盆腔肿瘤大手术围手术期VTE评估及预防,有效的预测了术后VTE发生的风险,减少了术后VTE的发生率。但是目前,针对泌尿外科手术专有VTE风险评估量表及预防指南仍是目前研究的方向。
[Abstract]:Objective: venous thromboembolism (venous thromboembolism VTE) is one of the common and serious complication after surgery, new VTE within 30 days. The mortality rate is high and the bladder and prostate cancer is mainly the Department of Urology of pelvic tumors, and its incidence is rising year by year in China. This paper aimed to collect our Hospital Department of Urology, pelvic tumor surgery (radical cystectomy, prostatectomy) in patients with clinical data, to understand the incidence and influencing factors of postoperative VTE, and summarize the experience of prevention and treatment of perioperative VTE. Methods: a retrospective analysis of hospitalized in the Department of Urology of our hospital in 2010 01 months to December 2016, diagnosed with bladder cancer or prostate cancer clinical data parallel cystectomy or radical prostatectomy for prostate cancer patients. To understand the incidence of postoperative VTE and perioperative venous thrombosis by Capirin evaluation model and phase Prevention measures before and after the VTE rate changes. Statistics related factors of patients and operation analysis of the impact on the occurrence of VTE after operation. At the same time, experience the retrieval of VTE related literature summary and the guidelines for prevention and treatment of Department of Urology, prevention and treatment of VTE. Results: according to the inclusion criteria and exclusion criteria, into the group of 316 patients. The whole bladder resection in 180 cases, the average age of 68.4 + 11.6 (38-91); the average BMI 24 + 3.1 (19.0-32.1) Kg/m2. in laparoscopic surgery in 124 cases (68.9%), 56 cases of open surgery (31.1%). The average operation time was 312.6 + 97.1 (140-600) min; the average bleeding 592.4 + 492.8 (50-2500) ml; perioperative blood transfusion in 56 cases (31.1%); patients with pelvic lymph node dissection in 157 cases (87.2%). Prostate cancer radical surgery in 136 cases, the average age of 71 + 7.2 (52-86); the average BMI 25.2 + 2.8 (20.6-34.1) Kg/m2. in laparoscopic surgery in 110 cases (80.9%), 26 cases of open surgery (19.1 %).骞冲潎鎵嬫湳鏃堕棿216.6卤76.4(60-420);骞冲潎鎵嬫湳鍑鸿��500.7卤636.6(30-4000)ml;鍥存墜鏈�鏈熻緭琛�23渚，

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