腹部外科病人术后症状性静脉血栓栓塞症多中心临床流行病学研究

目的探讨腹部外科病人术后症状性静脉血栓栓塞症(VTE)的流行病学特点。方法回顾性分析上海交通大学医学院附属第九人民医院、滁州市第一人民医院、郑州大学第二附属医院、上海市奉贤区奉城医院4家医院自2015-01-01—2019-06-30期间就诊于普通外科,入院后行腹部外科手术的病人共计24336例相关临床资料,并观察术后14 d内发生VTE事件的情况。结果VTE事件发生率为0.89%(216/24336),其中,深静脉血栓形成(DVT)发生率0.75%(183/24336),肺动脉栓塞(PE)发生率0.35%(86/24336)。男性VTE事件发生率为0.85%(123/14443),女性为0.94%(93/9893),男女VTE事件发生率差异无统计学意义(χ^2=2.15,P>0.05)。DVT病人常见的症状是下肢肿胀177例(96.72%),疼痛104例(56.83%),浅静脉曲张36例(19.67%)。PE病人常见的症状是呼吸困难和气促77例(89.53%),胸痛55例(63.95%)。DVT易累及左下肢;混合型最多见,左、右下肢分别为61.11%(88/144)和52.11(37/71)。PE病人最常见低危组病人45例(52.32%)。常见的VTE危险因素包括:年龄≥40岁208例(96.30%),手术时间>45 min 139例(64.35%),恶性肿瘤病史99例(45.83%)。主要的腹部外科手术类型是消化道恶性肿瘤手术105例(48.61%),胆囊切除术73例(33.80%)。腹腔镜手术(1.61%,179/11123)较开放手术(0.28%,37/13213)VTE事件发生率低(χ^2=45.56,P<0.05)。VTE相关病人的病死率为0.10%(25/24336)。结论腹部外科病人术后VTE发生率已经明显降低,医生应当根据其流行病学特点,早期发现,早期诊断和早期预防干预,避免严重不良事件的发生。

Multicenter clinical epidemiological study of symptomatic venous thromboembolism in patients with abdominal surgery

Multicenter clinical epidemiological study of symptomatic venous thromboembolism in patients with abdominal surgery CUI Chao-yi*, ZHANG-Rong, SONG Ju-min, et al. *Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Corresponding author：HUANG Xin-tian, E-mail：hunxt2013@163.com
Abstract Objective To investigate the epidemiological characteristics of symptomatic venous thromboembolism (VTE) in patients undergoing abdominal surgery. Methods The clinical data of patients from four hospitals (the Shanghai Ninth People’s Hospital of Shanghai Jiao Tong University School of Medicine; the First People’s Hospital of Chuzhou, Anhui Province; the Second Affiliated Hospital of Zhengzhou University, Henan Province; Fengcheng Hospital, Fengxian District, Shanghai) were analyzed retrospectively. The patients were performed abdominal surgery during January 1, 2015 to June 30, 2019. A total of 24 336 patients were included in the study. They were observed the occurrence of VTE events within 14 days after surgery. Results The incidence of VTE events was 0.89% (216/24 336). Among them, the incidence of deep venous thrombosis (DVT) was 0.75% (183/24 336), and the incidence of pulmonary embolism (PE) was 0.35% (86/24 336). There was no statistically significant difference in incidence between men and women ［(0.85%, 123/14 443) vs. (0.94%, 93/9893)，χ2=2.15, P＞0.05］. Common symptoms in patients with DVT were swelling of the lower limbs 177 cases (96.72%), pain 104 cases (56.83%), and superficial varicose veins 36 cases (19.67%). Common symptoms in patients with PE were dyspnea and shortness of breath 77 cases (89.53%) and chest pain 55 cases (63.95%). DVT easily affects the left lower limb and mixed types were most common, 61.11%（88/144）in left lower limb and 52.11（37/71）in right lower limb respectively. The most of PE patients were in low-risk group (45 cases, 52.32%). The most common VTE risk factors were age≥40 years (208 cases, 96.30%), surgery time＞45 mins (139 cases, 64.35%), and a history of malignant tumors (99 cases, 45.83%). The main types of abdominal surgery were gastrointestinal malignant tumors (105 cases, 48.61%) and cholecystectomy (73 cases, 33.80%). The incidence of VTE events was lower in laparoscopic surgery than that in open surgery ［(1.61%, 179/11 123) vs. (0.28%, 37/13 213), χ2=45.56，P＜0.05］. The mortality rate of VTE patients was 0.10% (25/24 336). Conclusion The incidence of postoperative VTE in patients underwent abdominal surgery has been significantly reduced. Clinicians should detect and diagnose early, and make early preventive interventions based on their epidemiological characteristics for preventing serious adverse events.