子宫内膜癌围手术期血栓发生的高危因素分析

发布时间：2018-04-24 05:19

本文选题：子宫内膜癌 + 深静脉血栓　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:回顾性分析我院和我院合作医院(菏泽市市立医院)子宫内膜癌患者围手术期发生血栓的相关高危因素,为围手术期血栓的有效预防提供有价值的参考。方法:收集2010年6月-2016年12月期间因子宫内膜癌于我院和我院合作医院(菏泽市市立医院)行妇科手术治疗患者病例共计564例,其中术后12天内发生下肢深静脉血栓的患者23例(发病率为4.08%),选择同期未发生下肢深静脉血栓的子宫内膜癌手术患者541例,并按1:20的比例随机选择26例作为对照组,研究指标包括年龄、体重指数、合并症(糖尿病、高血压、高血脂、心脏病及口服激素类药物史)、肿瘤分期、术后化疗或使用止血药物、手术前后血常规、凝血功能、血脂等。分析不同的临床病理参数、手术方式、手术范围、手术时间等与子宫内膜癌围手术期血栓发生的关系。血栓的诊断通过检查患者下肢情况及多普勒超声诊断等综合判断静脉血栓的发生情况。结果:子宫内膜癌患者围手术期发生血栓的年龄段多集中在40-59岁,随着年龄的增长,围手术期发生深静脉血栓的概率明显增加。血栓组体重指数显著高于对照组,分别为26.15±3.76 kg/m2与23.93±3.62 kg/m2(P=0.0408)。术前若有长期卧床史也增加了围手术期深静脉血栓发生的概率。血栓组合并症(包括糖尿病、高血压、高血脂、心脏病及口服激素类药物史)的数量和比例明显高于对照组。肿瘤分期对血栓形成有显著性影响(P=0.012),随着肿瘤时期的进展,血栓的发生率显著提高。血栓组术后红细胞压积值(0.32±0.065 L/L)显著低于术前(0.39±0.052 L/L);纤维蛋白原含量较对照组显著增高(分别为4.57±1.25g/L,2.73±0.81g/L)。而血栓组的高密度脂蛋白胆固醇含量明显低于对照组(分别为1.12±0.27mmol/L和1.46±0.31mmol/L,P=0.0002)。肿瘤晚期患者纤维蛋白原及血浆D-二聚体含量明显高于早期患者。手术时间越长,血栓发生的风险越高(2h、3h、4h及4h以上的患者血栓发生率分别为0.92%、5.91%、10.53%和28.99%)。随着手术范围的扩大,患者深静脉血栓的发生率显著提高。术后化疗或使用止血药也显著提高了子宫内膜癌围术期血栓的发生。结论:年龄、体重指数、合并症、手术时间、手术方式、肿瘤分期及术后化疗或使用止血药物为子宫内膜癌围手术期血栓发生的高危因素。
[Abstract]:Objective: to analyze the risk factors of perioperative thrombus in patients with endometrial carcinoma in our hospital and Heze City Hospital, so as to provide valuable reference for the effective prevention of perioperative thrombus. Methods: from June 2010 to December 2016, 564 cases of endometrial carcinoma were treated by gynecological surgery in our hospital and Heze City Hospital. Among them, 23 cases (incidence rate 4.08) of deep venous thrombosis of lower extremity occurred within 12 days after operation, 541 cases of endometrial carcinoma without lower extremity deep vein thrombosis were selected in the same period, and 26 cases were randomly selected as control group according to the proportion of 1:20. These include age, body mass index, complications (diabetes, hypertension, hyperlipidemia, heart disease and oral steroids), tumor staging, postoperative chemotherapy or use of hemostatic drugs, preoperative and postoperative blood routine, coagulation function, and blood lipids. To analyze the relationship between different clinicopathological parameters, surgical methods, surgical scope and operative time and perioperative thrombogenesis of endometrial carcinoma. In the diagnosis of thrombosis, the occurrence of venous thrombosis was judged by examination of lower extremity and Doppler ultrasound. Results: the age of perioperative thrombosis in patients with endometrial carcinoma was mainly 40-59 years old. With the increase of age, the probability of deep venous thrombosis in perioperative period increased significantly. The BMI of thrombus group was significantly higher than that of the control group (26.15 卤3.76 kg/m2 and 23.93 卤3.62 kg / m ~ (-2) 路min ~ (-2)) respectively. Long-term history of bed-rest before operation also increased the risk of perioperative deep venous thrombosis. The number and proportion of complications (including diabetes, hypertension, hyperlipidemia, heart disease and oral hormone history) in thrombus group were significantly higher than those in control group. Tumor staging had a significant effect on thrombosis. With the progression of tumor stage, the incidence of thrombus increased significantly. In the thrombus group, the hematocrit value was 0.32 卤0.065 L / L and the fibrinogen content was significantly higher than that in the control group (4.57 卤1.25 g / L, 2.73 卤0.81g / L, respectively). However, the high density lipoprotein cholesterol content in the thrombus group was significantly lower than that in the control group (1.12 卤0.27mmol/L and 1.46 卤0.31 mmol / L, 0.0002, respectively). The levels of fibrinogen and plasma D-dimer in patients with advanced tumor were significantly higher than those in early patients. The longer the operation time, the higher the risk of thrombosis. The incidence of thrombus in the patients with 2 h or 3 h and more than 4 h was 0.92% and 28.99%, respectively. With the expansion of the scope of surgery, the incidence of deep venous thrombosis increased significantly. Postoperative chemotherapy or the use of hemostatic drugs also significantly increased the incidence of perioperative thrombus in endometrial carcinoma. Conclusion: age, body mass index (BMI), complications, operative time, operative method, tumor staging and postoperative chemotherapy or use of hemostatic drugs are the risk factors for perioperative thrombosis of endometrial carcinoma.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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