胃癌围手术期下肢深静脉血栓形成的危险因素分析

发布时间：2018-12-10 20:35

【摘要】：目的探讨胃癌围手术期下肢深静脉血栓形成的临床特点和危险因素。方法选择我院胃肠外科2015年2月~2016年9月收治的胃癌患者167例,收集所有患者的临床资料,将不符合入组标准的患者排除。按照有无下肢静脉血栓形成分为有血栓组和无血栓组,选择年龄、性别、职业、体重指数(body mass indexBMI)、吸烟、饮酒、手术方式、手术时间、术后用止血药、术后感染或吻合口瘘、高血压、糖尿病等可能影响胃癌围手术期下肢DVT形成的因素进行危险因素分析,并建立模型,预测胃癌围手术期患者的危险层次。单因素分析采用卡方检验,多因素分析采用二分类Logistic多元回归,设定P0.05为有统计学意义。结果我院2015年2月-2016年9月收治的167例胃癌患者中,3例患者因临床资料不完善或其他原因而被排除,164例患者入选。入选的164例患者中,下肢DVT的发病率为14.02%(23/164)。23例下肢DVT患者中,男14例(60.9%),女9例(39.1%);年龄27~82岁,平均年龄59.8±4.9岁;无临床症状者19例(82.6%),有症状者4例(17.4%),无一例出现肺栓塞相关症状;血栓发生于左下肢10例(43.4%),右下肢6例(26.1%),双下肢7例(30.4%);主要分布静脉依次为小腿肌间静脉19例(82.6%),腓静脉3例(13.0%),胫后静脉1例(4.3%)。通过单因素分析后,控制混杂因素,经二分类多因素回归分析得出年龄≥60岁、BMI≥25?kg/m2、高血压(P??0.001)、术后并发症(术后感染、吻合口瘘)、手术时间3.5小时、术后使用止血药等是胃癌围手术期独立危险因素。危险等级预测模型:没有相关危险因素未发现下肢DVT患者,1个危险因素的为4.8%,2个危险因素的为27.88%,危险因素≥3个的为43.75%。结论1、胃癌围手术期下肢DVT发生率高,主要为无症状小腿肌间型血栓。左下肢较右下肢更容易形成。2、年龄≥60岁、高血压、术后并发症(术后感染、吻合口瘘)、术后使用止血药、BMI≥25?kg/m2、手术时间3.5小时等是胃癌围手术期发生下肢DVT的独立危险因素。3、针对发生下肢DVT的中、高危胃癌围手术期患者,早期的诊断和预防,能够降低其下肢DVT的发生率。
[Abstract]:Objective to investigate the clinical characteristics and risk factors of deep venous thrombosis in lower extremity during perioperative period of gastric cancer. Methods 167 patients with gastric cancer admitted in our hospital from February 2015 to September 2016 were selected and the clinical data of all patients were collected and excluded. Patients were divided into thrombus group and non-thrombus group. Age, sex, occupation, body mass index (body mass indexBMI),) smoking, drinking, operation time, postoperative hemostatic drugs were selected. Risk factors of postoperative infection or anastomotic fistula, hypertension and diabetes were analyzed to predict the risk level of gastric cancer perioperative patients. Single factor analysis using chi-square test, multivariate analysis using two-class Logistic multiple regression, set P0.05 as statistically significant. Results among 167 cases of gastric cancer treated in our hospital from February 2015 to September 2016, 3 cases were excluded because of incomplete clinical data or other reasons, 164 cases were selected. The incidence of lower extremity DVT was 14.02% (23 / 164) among the 164 patients, 14 (60.9%) were male and 9 (39.1%) were female, the average age was 59.8 卤4.9 years old (2782 years), and 14 cases (60.9%) were male and 9 cases (39.1%) in lower extremity DVT. There were 19 cases (82.6%) without clinical symptoms and 4 cases (17.4%) with symptoms. Thrombosis occurred in 10 cases (43.4%) of the left lower limb, 6 cases (26.1%) of the right lower extremity and 7 cases (30.4%) of the bilateral lower limbs. The main distributed veins were the intermuscular vein of the leg in 19 cases (82.6%), the peroneal vein in 3 cases (13.0%) and the posterior tibial vein in 1 case (4.3%). After univariate analysis, the confounding factors were controlled, and the age 鈮，

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