卵巢癌患者围手术期静脉血栓栓塞发生危险因素及治疗分析

发布时间：2018-09-02 05:36

【摘要】：目的:卵巢恶性肿瘤患者发生静脉血栓栓塞(VTE)的风险较高,这不仅导致了患者在诊断和治疗上花费昂贵,而且严重威胁患者的生命健康。然而,关于卵巢癌患者合并静脉血栓的相关高危因素及如何治疗围手术期合并静脉血栓的卵巢癌患者方面,目前研究较少。因此,我们拟通过分析评估卵巢癌患者合并静脉血栓栓塞(venous thromboembolism,VTE)发生的危险因素,为围手术期血栓的预防和治疗提供参考。方法:本研究收集并回顾分析了山东大学齐鲁医院卵巢上皮性癌患者的临床资料,研究的对象是自2014年1月1日到2017年1月1日于该院住院并接受化疗和手术治疗,最终病理确诊为卵巢癌的患者。在本研究中,我们采用不同的统计方法分析这些患者的相关临床因素,分析卵巢癌合并VTE的术前和术后相关危险因素,探讨如何在围手术期治疗和预防静脉血栓栓塞。结果:在接受手术治疗并最终确诊为卵巢癌的388例患者中,有35例患者出现了VTE,其中包括术前VTE患者15例,术后发生VTE 20例,335的患者手术前后均未发生静脉血栓,18例卵巢癌患者因临床资料不完整而排除。在35例VTE形成患者中,确诊为肺栓塞者共8例,其中包括术前PE 4例,术后4例(其中1例发生于术后5个月,肿瘤未控,发生肺栓塞和下肢静脉栓塞),术后肺栓塞死亡1例,肺栓塞死亡率为12.5%,其余患者为不同部位的深静脉血栓(DVT)。对4例术前发现肺栓塞的患者,我们于手术前给予了 2个周期的化疗,同时用LMWH进行抗凝治疗。经过这些处理后,4例肺栓塞患者症状消失,腹水情况好转,肿瘤肿块大小明显下降,之后对这4例患者均实施了满意的肿瘤细胞减灭术。对患者的临床相关因素用T检验及x2检验进行分析后,我们发现血栓组和非血栓组在年龄、术前D-二聚体值、血小板数值、术前是否辅以新辅助化疗、是否合并心血管疾病以及手术时间、术后是否应用抗凝药物等差别均有统计学意义(P0.05),通过多因素分析发现,年龄55岁,术前D-二聚体值0.5ug/mml、血小板300*109/L、肿瘤直径10cm是术前VTE发生的高危因素;D-二聚体值0.5ug/ml、手术时间150min是术后VTE发生的高危因素。结论:围手术期发生VTE对卵巢癌患者可能造成致命性的严重后果,在妇科手术之前应进行积极的术前筛查,并积极采用围手术期预防措施,尤其是对于存在这项研究中确定的风险因素的患者。对年龄较大、肿瘤较大、术前D-二聚体值或血小板数值较高的患者应引起高度重视,减少手术时间及术后积极应用抗凝药物可预防深静脉血栓形成。对于术前已经发现VTE尤其是肺栓塞的卵巢癌患者,可先给予新辅助化疗及抗凝药物控制血栓进展及癌灶发展,可提供更好的手术时机,对患者的治疗颇有必要。
[Abstract]:Objective: the risk of venous thromboembolism (VTE) in patients with malignant ovarian tumors is high, which not only leads to the high cost of diagnosis and treatment, but also seriously threatens the life and health of patients. However, there are few studies on the risk factors associated with venous thrombosis in patients with ovarian cancer and the treatment of ovarian cancer patients with venous thrombosis during perioperative period. Therefore, we intend to evaluate the risk factors of ovarian cancer patients with venous thromboembolism (venous thromboembolism,VTE) and provide reference for the prevention and treatment of perioperative thromboembolism. Methods: the clinical data of patients with ovarian epithelial carcinoma in Qilu Hospital of Shandong University were collected and analyzed retrospectively. The subjects of the study were hospitalized from January 1, 2014 to January 1, 2017, and received chemotherapy and surgical treatment. The final pathological diagnosis of ovarian cancer patients. In this study, we used different statistical methods to analyze the relevant clinical factors of these patients, to analyze the risk factors of ovarian cancer complicated with VTE before and after operation, and to explore how to treat and prevent venous thromboembolism in perioperative period. Results: of the 388 patients who underwent surgical treatment and were finally diagnosed with ovarian cancer, 35 had VTE, including 15 patients with preoperative VTE. No venous thrombosis occurred before and after operation in 20 patients with VTE and 18 patients with ovarian cancer were excluded because of incomplete clinical data. Among the 35 patients with VTE, 8 cases were diagnosed as pulmonary embolism, including 4 cases of preoperative PE, 4 cases of postoperative PE (1 case occurred 5 months after the operation, the tumor was not controlled, pulmonary embolism and venous embolism of lower extremity), and 1 case died of postoperative pulmonary embolism. The mortality rate of pulmonary embolism was 12.5. The rest of the patients had deep venous thrombosis (DVT).) at different sites. Four patients with pulmonary embolism before operation were treated with two cycles of chemotherapy and anticoagulant therapy with LMWH. After these treatments, the symptoms of 4 patients with pulmonary embolism disappeared, the ascites condition improved, and the tumor mass size decreased significantly. After that, satisfactory tumor cell reduction was performed in all of the 4 patients. After analyzing the clinical related factors of the patients by T test and x2 test, we found that the age, the preoperative D- dimer value, the platelet value and the preoperative neoadjuvant chemotherapy were found in the thrombus group and non-thrombotic group. There were significant differences in cardiovascular disease and operative time after operation and whether anticoagulant drugs were used after operation (P0.05). The age of 55 years was found by multivariate analysis. Preoperative D- dimer value was 0.5ug.mml, platelets was 300-109L, tumor diameter 10cm was the high risk factor of preoperative VTE. 150min was the high risk factor of postoperative VTE. Conclusion: perioperative VTE may cause fatal consequences for patients with ovarian cancer. Active preoperative screening should be carried out before gynecological surgery, and perioperative preventive measures should be used actively. This is especially true for patients with risk factors identified in this study. For the older patients with larger tumors and the higher preoperative D- dimer or platelet values, great attention should be paid to the prevention of deep venous thrombosis by reducing the operation time and actively applying anticoagulant drugs after operation. For ovarian cancer patients who have found VTE especially pulmonary embolism before operation, neoadjuvant chemotherapy and anticoagulant drugs can be given first to control the progression of thrombus and cancer focus, which can provide a better opportunity for operation and is necessary for the treatment of patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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