摘要
目的:分析胰腺癌患者术后静脉血栓栓塞症(VTE)的发生情况及其危险因素。方法:选取2017年6月—2021年12月在安徽省庐江县人民医院及首都医科大学附属北京朝阳医院接受了根治性胰十二指肠切除术的346例胰腺癌患者,回顾性分析其基本信息(年龄、性别、身高、体质量等)、实验室检查(白细胞计数、淋巴细胞计数、血小板计数、D-二聚体、组织因子等)、手术的相关信息(血管重建方式、手术时长、出血量等)、肿瘤病理资料(肿瘤类型、分化程度等)。所有患者术前、术后均进行下肢静脉超声检查。根据作者术后是否新发VTE组(41例)和非VTE组(305例),比较两组患者的临床病例差异,采用多因素Logistic回归分析胰腺癌患者术后新发VTE的危险因素。结果:所有胰腺癌患者均顺利完成手术,术后共41例发生VTE,发生率为11.8%;余305例为无VTE组。两组患者淋巴细胞计数,组织因子,术前、术后第1天、第3天D-二聚体水平及血管重建方式差异有统计学意义;VTE组手术时长大于无VTE组,差异有统计学意义(P<0.05)。本组所有患者术后病理结果均为胰腺导管腺癌,其中,中、高分化217例,低分化129例,两组的分化程度差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高龄、组织因子升高、D-二聚体(术后第1天)升高、进行同种异体血管置换是胰腺癌术后发生VTE的独立危险因素(P<0.05),淋巴细胞计数升高是其保护因素(P<0.05)。结论:胰腺癌术后VTE发生率较高,高龄、组织因子升高、D-二聚体(术后第1天)升高及进行同种异体血管置换是胰腺癌术后发生VTE的独立危险因素,而较高的淋巴细胞计数往往意味着更低的VTE发生可能。
Objective The purpose of this study was to analyse the clinical characteristics and risk factors of venous thromboembolism(VTE)in order to comprehensively predict the prevalence and risk factors of it in patients undergoing radical pancreatoduodenectomy.Methods Basic information,laboratory examination and pathological data of 346 consecutive patients who underwent radical pancreatoduodenectomy in Lujiang County People’s Hospital and Beijing Chaoyang Hospital from June 2017 to December 2021 were retrospectively analyzed.All patients were examined by lower limb vein ultrasonography before and after operation.VTE Group(n=45)and non-VTE group(n=305)according to whether they had new VTE after surgery,and the Patients were divided into clinicopathological date of the two group were compared,and the risk factors of postoperative VTE were analyzed by multivariate logistic regression.Results All patients completed the operation successfully,and 41 patients developed VTE after operation,with an incidence of 11.8%,the remaining 305 cases were in the non-VTE group.There were significant differences in lymphocyte count,tissue factor,D-dimer level before operation,on day 1 and day 3 after operation,and vascular reconstruction mode between the two groups.The operation time of VTE group was longer than that of no VTE group,and the difference was statistically significant(P<0.05).The postoperative pathological results of all patients in this group were pancreatic ductal adenocarcinoma,among which 217 cases were moderately and highly differentiated and 129 cases were poorly differentiated.There was a statistically significant difference in the degree of differentiation between the two groups(P<0.05).Multivariate logistics regression analysis showed that advanced age,elevated tissue factor,elevated D-dimer(the first day after operation),all ovascular replacement and tumor differentiation were independent risk factors for VTE after lung surgery(P<0.05),meanwhile,increased lymphocyte count was the protective factor(P<0.05).Conclusion Advanced age,elevated tissue factor,elevated D-dimer(the first day after operation),allovascular replacement and tumor differentiation were independent risk factors for VTE after operation,while higher lymphocyte count often meant lower VTE in patients following radical pancreatoduodenectomy.
作者
王明
崔松平
汪京
李立详
汪志忠
星军华
金中奎
WANG Ming;CUI Song-ping;WANG Jing(Department of Emergency,Lujiang County People's Hospital,Hefei(231500),China)
出处
《中国中西医结合外科杂志》
CAS
2022年第5期639-644,共6页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
关键词
静脉血栓栓塞症
肺栓塞
胰腺癌
根治性胰十二指肠切除术
血管重建
Venous thromboembolism
pulmonary embolism
pancreatic carcinoma
radical pancreatoduodenectomy
vascular reconstruction mode
