结直肠癌术后静脉血栓栓塞症形成的危险因素预防和治疗分析

Risk factors and prevention and treatment of venous thromboembolism after colorectal cancer surgery

摘要:

目的?探讨结直肠癌术后发生静脉血栓栓塞症（VTE）的危险因素及防治措施。方法?回顾性分析2012年5月—2018年12月甘肃省人民医院收治的86例结直肠癌术后发生VTE的患者作为病例组，选取同期入院行结直肠癌根治手术后未发生VTE的84例患者作为对照组。分析结直肠癌术后发生VTE的危险因素，结合其临床表现、辅助检查及治疗方法，进一步阐述结直肠癌术后VET的诊疗方法。 结果?两组在性别、体重指数≥30?kg/m 2（中度肥胖）、糖尿病、高血压、新辅助化疗、手术术式（造瘘）、手术方式（开腹结直肠癌根治术）、输血、使用止血药物及感染方面比较，差异有统计学意义（P?<0.05）。两组年龄、血小板（PLT）、D-二聚体比较，差异有统计学意义（P?<0.05）。Logistic回归分析结果显示，年龄>53.5岁[OlR=2.258（95% CI：1.019，5.044）]，糖尿病[OlR=2.688（95% CI：1.237，5.842）]、新辅助化疗[OlR=2.424（95% CI：1.147，5.123）]、输血[OlR=2.559（95% CI：1.073，6.103）]、手术方式[OlR=2.044（95% CI：1.044，4.002）]、PLT[OlR=7.800（95% CI：2.689，22.625）]及D-二聚体[OlR=25.416（95% CI：8.726，74.013）]是结直肠癌术后VTE形成的危险因素。结论?对好发VTE的患者应该加强术后护理，早期下床活动，给予双下肢气压治疗，促进下肢静脉回流，必要时予以低分子肝素钙预防；若术后发生VTE，则根据患者出血风险和具体情况制定诊疗措施。

Abstract:

Objective?To explore the risk factors, prevention and treatment of venous thromboembolism in patients who underwent radical resection of colorectal cancer.?Methods?A total of 86 patients with colorectal cancer in Gansu Provincial People’s Hospital who suffered from venous thromboembolism (VTE) after operation during May 2012 to December 2018 were retrospectively selected as the case group, and 84 cases without VTE after surgery in the same period were selected as the control group by systematic sampling. The risk factors of VTE after surgery were investigated, and the diagnosis and treatment methods were further elaborated by combining clinical manifestations, auxiliary examinations and current treatments.?Results?The clinical characteristics of the patients in gender, moderate obesity, diabetes, high blood pressure, neoadjuvant chemotherapy, surgical method, surgery procedures, the use of hemostatic drugs, blood transfusion, and infection were significantly different between the case group and control group (P < 0.05). Besides, there were statistically significant differences in age, platelet (PLT) count and D-dimer levels between the case group and the control group (P < 0.05). Logistic regression analysis showed that age > 53.5 years old [OlR?=?2.258, (95% CI: 1.019, 5.044)], diabetes mellitus [OlR?=?2.688, (95% CI: 1.237, 5.842)], neoadjuvant chemotherapy [OlR?=?2.424, (95% CI: 1.147, 5.123)], blood transfusion [OlR?=?2.559, (95% CI: 1.073, 6.103)], surgical method [OlR?=?2.044, (95% CI: 1.044, 4.002)], PLT count [OlR?=?7.800, (95% CI: 2.689, 22.625)], and D-dimer level [OlR?=?25.416, (95% CI: 8.726, 74.013)] were risk factors for the development of VTE after colorectal cancer surgery.?Conclusions?The nursing and early ambulation after surgery should be emphasized, and the pressure therapy should be given to promote the venous return in the lower limbs. The low-molecular-weight heparin calcium can be administered to prevent the occurrence of VTE when necessary. If the patients suffered from VTE, the treatment regimens should be formulated based on the bleeding risk and specific conditions of VTE.