肿瘤相关因素与胃癌患者术后下肢深静脉血栓形成的关系研究

Study on the relationship between tumor-related factors and postoperative venous thrombosis of lower extremities in patients with gastric malignant tumor

摘要:

目的 探讨肿瘤相关因素与胃癌患者术后下肢深静脉血栓形成之间的关系，为肿瘤患者术后血栓防治提供参考。方法 收集2016年10月—2018年12月于郑州大学第一附属医院胃肠外科手术的258例胃癌患者的临床资料，统计手术后患者下肢深静脉血栓形成（DVT）人数，分析肿瘤相关因素对下肢DVT的影响。结果 135例患者中，术后发生下肢DVT 60例（44.4%），其中左下肢19例（14.1%），右下肢11例（8.1%），双侧下肢30例（22.2%）。根据术后下肢DVT情况分为血栓组和非血栓组。两组术前是否行新辅助化疗和手术后CA125水平比较，差异有统计学意义（P <0.05）。多因素Logistic回归分析结果显示手术后CA125水平升高超过5 u/ml［R=3.227（95% CI：1.181，8.812）］是术后下肢DVT发生的危险因素。新辅助化疗后两组缓解率比较，差异有统计学意义（P =0.018），非血栓组缓解率更高。结论 术后CA125水平较术前升高超过5 u/ml的患者术后发生下肢DVT的人数明显增加；新辅助化疗后病情缓解的患者术后发生血栓的风险降低。

Abstract:

Objective To analyze the correlation between tumor-related factors and lower limb venous thrombosis after operation of gastric malignant tumor, so as to provide reference for postoperative thrombosis prevention and treatment of tumor patients.Methods From October 2016 to December 2018, 258 patients with gastric malignant tumor who were admitted to gastrointestinal surgery in the First Affiliated Hospital of Zhengzhou University were monitored by color Doppler ultrasound for venous thrombosis of lower extremity before and after operation. The thrombosis of lower extremity before and after operation, and the clinical parameters related to tumor factors were counted, and the effect on DVT of lower extremity was analyzed.Results A total of 135 patients were enrolled in the study. Postoperative DVT occurred in 60 patients (44.4%), including 19 patients (14.1%) with left lower limb, 11 patients (8.1%) with right lower limb, and 30 patients (22.2%) with bilateral lower limb. Univariate chi-square analysis showed that preoperative neoadjuvant chemotherapy and postoperative blood CA125 level increased by more than 5 u/ml were the risk factors of postoperative lower limb thrombosis (P < 0.05). Multivariate analysis was carried out on the increase of blood CA125 level over 5 u/ml after surgery and neoadjuvant chemotherapy. The results showed that the increase of blood CA125 level over 5 u/ml [R = 3.227 (95% CI: 1.181, 8.812)] after surgery was a risk factor for postoperative lower limb thrombosis. Fisher exact probability method was used to analyze the remission rate of thrombi group and non-thrombi group after neoadjuvant chemotherapy. The results showed that the remission rate of non-thrombi group was higher and the difference was statistically significant (P = 0.018).Conclusion The incidence of postoperative lower limb thrombosis was significantly increased in patients with postoperative blood CA125 level increased by more than 5 U/ml compared with that before operation. Patients with remission after neoadjuvant chemotherapy have a lower risk of postoperative thrombosis.