腹腔镜结直肠癌术后下肢深静脉血栓形成的危险因素分析

Analysis of risk factors of lower extremity deep venous thrombosis after laparoscopic surgery for colorectal cancer

摘要:

目的 探讨腹腔镜结直肠癌术后下肢深静脉血栓形成（LDVT）的危险因素，为临床结直肠癌术后预防及治疗LDVT提供思路和理论依据。方法 选取2021年1月—2022年1月在西南医科大学附属医院胃肠外科就诊的154例行腹腔镜结直肠癌根治术患者，依据排除标准剔除4例，最终纳入150例。根据患者术后2周内是否发生LDVT分为血栓组（41例）和非血栓组（109例），采用单因素和多因素二元Logistic回归分析腹腔镜结直肠癌术后LDVT形成的危险因素。结果 单因素分析结果显示，两组患者年龄、手术时间、术后卧床时间、术前合并基础疾病、术后并发症、白细胞、D-二聚体（D-D）、脉管侵犯比较，差异均有统计学意义（P < 0.05）；而性别、体质量指数、凝血指标、术中失血量、肿瘤TNM分期、肿瘤分型、分化程度、神经侵犯比较，差异无统计学意义（P > 0.05）。多因素二元Logistic回归分析结果显示，年龄 ≥ 63岁［O^R =2.823（95% CI：1.047，7.616）］、术前合并基础疾病［O^R =3.561（95% CI：1.348，9.406）］、术后并发症［O^R =8.739（95% CI：2.498，30.575）］、D-D［O^R =1.185（95% CI：1.012，1.387）］是腹腔镜结直肠癌术后LDVT形成的危险因素。结论 腹腔镜结直肠癌术后LDVT的发生率高，年龄≥ 63岁、术前合并基础疾病、术后出现感染并发症、D-二聚体升高是其主要危险因素。

Abstract:

Objective To explore the risk factors of lower extremity deep vein thrombosis (LDVT) after laparoscopic colorectal cancer surgery, and provide clinical ideas and theoretical basis for the prevention and treatment of LDVT after colorectal cancer surgery.Methods From January 2021 to January 2022, 154 patients with colorectal cancer who underwent laparoscopic radical resection of colorectal cancer were selected from the Department of Gastroenterology, Affiliated Hospital of Southwest Medical University. Four patients were excluded according to the exclusion criteria, and 150 patients were finally included. According to whether LDVT occurred within 2 weeks after operation, the patients were divided into blood thrombotic group (41 cases) and non-thrombotic group (109 cases), The risk factors of LDVT formation after laparoscopic colorectal cancer surgery were analyzed by univariate and multivariate logistic regression.Results The results of univariate analysis showed that there were statistically significant differences between the two groups in terms of age, operation time, postoperative bedtime, preoperative complications, basic diseases, postoperative complications, white blood cells (WBC), D-dimer (D-D), and vascular invasion (P < 0.05); There was no significant difference in sex, body mass index (BMI), coagulation index, intraoperative blood loss, tumor TNM stage, tumor classification, differentiation degree and nerve invasion (P > 0.05). Multivariate binary logistic regression analysis showed that age ≥ 63 years old [O^R = 2.823 (95% CI: 1.047, 7.616) ], preoperative complications [O^R = 3.561 (95% CI: 1.348, 9.406) ], postoperative complications [O^R = 8.739 (95% CI: 2.498, 30.575) ], and D-D [O^R = 1.185 (95% CI: 1.012, 1.387) ] were independent risk factors for the formation of LDVT.Conclusion The incidence of LDVT after laparoscopic colorectal cancer surgery is high, and the main risk factors are age ≥ 63 years old, preoperative complications, postoperative infection complications, and D-dimer elevation.