预防妇科恶性肿瘤术后静脉血栓的回顾性研究

发布时间：2018-05-18 04:28

本文选题：静脉血栓 + 预后　；参考：《现代妇产科进展》2015年02期

【摘要】：目的:探讨妇科恶性肿瘤术后静脉血栓预防措施的有效性。方法:选取2008年10月至2014年2月在苏北人民医院行妇科手术治疗的564例妇科恶性肿瘤患者,其中宫颈癌359例、子宫内膜癌110例和卵巢癌95例。根据术后危险程度分级采取不同的预防措施。中危患者(82例):术中采用弹力袜对下肢加压,术后连续3天静脉滴注低分子右旋糖酐500ml/d;高危(90例)和极高危患者(392例):术中采用弹力袜对下肢加压,并应用至术后1周;术后第一天静脉滴注低分子右旋糖酐500ml,术后第二天皮下注射依诺肝素钠0.4ml/d,连续应用5天。比较低分子右旋糖酐、低分子肝素及弹力袜不同联合方法对术后静脉血栓的预防效果。结果:564例患者中30例发生静脉血栓栓塞(VTE),其中深静脉血栓(DVT)22例(3.9%),肺栓塞(PE)2例(0.4%)、DVT合并PE 6例(1.1%)。宫颈癌、子宫内膜癌和卵巢癌患者术后发生VTE者分别有16例、8例和6例,3组比较差异均无统计学意义(P0.05)。564例妇科恶性肿瘤患者中40岁者术后无VTE发生,40~49岁、50~59岁和60岁患者中术后发生VTE者分别有5例、12例和13例,3组比较差异有统计学意义(P=0.027)。中危、高危、极高危患者的术后静脉血栓发生率分别为3.7%、4.4%和5.8%,3组比较差异无统计学意义(P0.05)。结论:低分子右旋糖酐、低分子肝素及弹力袜可有效预防患者术后静脉血栓的发生。根据患者不同的危险程度,选用不同方法预防,可避免过度治疗,降低术后出血。
[Abstract]:Objective: to investigate the effectiveness of preventive measures for postoperative venous thrombosis in gynecological malignant tumors. Methods: from October 2008 to February 2014, 564 patients with gynecological malignant tumors were treated by gynecological surgery in Subei people's Hospital, including 359 cases of cervical cancer, 110 cases of endometrial carcinoma and 95 cases of ovarian cancer. Different preventive measures were taken according to the grade of risk after operation. Eighty-two cases of moderate risk patients were treated with elastic socks for lower extremity compression during operation and intravenous drip of low-molecular-weight dextran 500ml / d (90 cases) and extremely high risk patients (392cases) for 3 days after operation. During the operation, elastic socks were used to compress the lower extremities and applied to 1 week after operation. Low molecular weight dextran 500 ml was injected intravenously on the first day after operation, followed by subcutaneous injection of enoxaparin sodium 0.4 ml / d for 5 days. The preventive effects of low molecular weight dextran, low molecular weight heparin and elastic socks on postoperative venous thrombosis were compared. Results VTET was found in 30 out of 564 patients, including DVT in 22 patients with DVT and PEI in 2 patients with PE in 6 patients. Cervical cancer, There were 16 cases of endometrial carcinoma and 6 cases of ovarian cancer developed VTE after operation. There was no significant difference among the 3 groups. There was no significant difference between 40 years old patients with 40 years old and 60 years old patients of 50 ~ 59 years old and 60 years old in 40 years old patients with gynecological malignant tumor. There were 5 cases with VTE and 13 cases with VTE after operation. The difference was statistically significant (P < 0. 027). The incidence of postoperative venous thrombosis in patients with moderate risk, high risk and very high risk was 3.4% and 5.8%, respectively. There was no significant difference among the three groups (P 0.05). Conclusion: low molecular weight dextran, low molecular weight heparin and elastic socks can effectively prevent postoperative venous thrombosis. According to the different degree of risk, different methods of prevention can avoid overtreatment and reduce postoperative bleeding.
【作者单位】：扬州大学临床医学院妇产科;苏北人民医院妇产科;
【分类号】：R737.3

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