| 子宫肌瘤经腹腔镜剔除术后并发下肢深静脉血栓风险评分系统的建立 |
| |
| 引用本文： | 梁惠霞,林淑媛,范蔚芳,董纪秀. 子宫肌瘤经腹腔镜剔除术后并发下肢深静脉血栓风险评分系统的建立[J]. 国际妇产科学杂志, 2022, 49(4): 398-402. DOI: 10.12280/gjfckx.20211183 |
| |
| 作者姓名： | 梁惠霞 林淑媛 范蔚芳 董纪秀 |
| |
| 作者单位： | 362000 福建省泉州市,中国人民解放军联勤保障部队第九一医院妇产科 |
| |
| 摘 要： | 目的：探讨子宫肌瘤经腹腔镜剔除术后并发下肢深静脉血栓（deep vein thrombosis,DVT）的危险因素,并构建风险列线图模型。方法：回顾性分析2017年1月—2021年1月在中国人民解放军联勤保障部队第九一○医院行腹腔镜剔除术的子宫肌瘤患者493例的临床资料,根据患者术后是否发生DVT分为DVT组和非DVT组,比较2组的临床情况,采用单因素和多因素Logistic回归分析筛选子宫肌瘤经腹腔镜剔除术后并发DVT的影响因素,根据独立危险因素建立列线图风险模型并进行预测效能验证。结果：493例行腹腔镜剔除术的子宫肌瘤患者中,术后并发下肢DVT者41例,发生率为8.32%（41/493）;2组年龄、体质量指数、术前合并症、麻醉方式、手术时间、术中气腹压力、血浆D-二聚体以及术后卧床时间等比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,年龄≥60岁（OR=3.786,95%CI：1.749~8.197）、术前合并症（OR=3.390,95%CI：1.524~7.543）、全身麻醉（OR=3.778,95%CI：1.722~8.287）、手术时间≥2 h（OR=2.884,95%CI：1.384~6.010）、术中气腹压力≥15 mmHg（1 mmHg=0.133 kPa,OR=3.295,95%CI：1.539~7.055）、血浆D-二聚体≥500 ng/mL（OR=4.141,95%CI：1.925~8.909）以及术后卧床时间≥5 d（OR=3.628,95%CI：1.710~7.697）均为子宫肌瘤患者术后并发下肢DVT的独立危险因素（P<0.05）。基于7项独立危险因素建立子宫肌瘤患者腹腔镜剔除术后并发DTV的列线图预警模型,结果显示年龄≥60岁为93分、术前合并症为85分、全身麻醉为93分、手术时间≥2 h为74分、术中气腹压力≥15 mmHg为83分、血浆D-二聚体≥500 ng/mL为100分、术后卧床时间≥5 d为91分,模型验证结果显示一致性指数为0.853（95%CI：0.822~0.884）,校正曲线的预测值与实测值基本一致,内部验证妇科腹部手术患者合并下肢DVT的风险列线图模型的ROC曲线下面积为0.832（95%CI：0.804~0.860）。结论：年龄≥60岁、术前合并症、全身麻醉、手术时间≥2 h、术中气腹压力≥15 mmHg、血浆D-二聚体≥500 ng/mL以及术后卧床时间≥5 d均为子宫肌瘤经腹腔镜剔除术后并发下肢DTV的独立危险因素,基于以上7项独立危险因素所建立的列线图有助于预测子宫肌瘤经腹腔镜剔除术后并发下肢DTV的发生风险。
|
| 关 键 词： | 子宫肿瘤 平滑肌瘤 腹腔镜 静脉血栓形成 危险因素 列线图 |
| 收稿时间： | 2021-12-28 |
Preliminary Establishment of Risk Scoring System for Deep Vein Thrombosis of Lower Extremities after Laparoscopic Removal of Uterine Fibroids |
| |
| LIANG Hui-xia,LIN Shu-yuan,FAN Wei-fang,DONG Ji-xiu. Preliminary Establishment of Risk Scoring System for Deep Vein Thrombosis of Lower Extremities after Laparoscopic Removal of Uterine Fibroids[J]. Journal of International Obstetrics and Gynecology, 2022, 49(4): 398-402. DOI: 10.12280/gjfckx.20211183 |
| |
| Authors: | LIANG Hui-xia LIN Shu-yuan FAN Wei-fang DONG Ji-xiu |
| |
| Affiliation: | Department of Obstetrics and Gynecology, The 910 Hospital of the Joint Logistics and Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China |
| |
| Abstract: | Objective：To investigate the risk factors of lower extremity deep vein thrombosis (DVT) after laparoscopic excision of uterine fibroids, and to establish a risk nomogram model. Methods：The clinical data of 493 patients with uterine fibroids who underwent laparoscopic excision in our hospital from January 2017 to January 2021 were retrospectively analyzed, and the patients were divided into DVT group and non-DVT group according to whether DVT occurred after operation. According to the clinical conditions of the group, univariate and multivariate Logistic regression analysis was used to screen the influencing factors of DVT after laparoscopic removal of uterine fibroids, and a nomogram risk model was established based on independent risk factors to verify the predictive efficacy. Results：Among 493 patients with uterine fibroids who underwent laparoscopic excision, 41 cases were complicated with lower extremity DVT after operation, and the incidence rate was 8.32% (41/493). The differences were statistically significant (P<0.05) when comparing age, body mass index, preoperative comorbidities, anesthesia, operative time, intraoperative pneumoperitoneal pressure, plasma D-dimer, and postoperative bed rest in the two groups. Multivariate Logistic regression analysis showed that age ≥ 60 years (OR=3.786, 95%CI: 1.749-8.197), preoperative comorbidities (OR=3.390, 95%CI: 1.524-7.543), general anesthesia (OR=3.778, 95%CI: 1.722-8.287), operation time ≥ 2 h (OR=2.884, 95%CI: 1.384-6.010), intraoperative pneumoperitoneum pressure ≥ 15 mmHg (OR=3.295, 95%CI: 1.539-7.055), plasma D-dimer ≥ 500 ng/mL (OR=4.141, 95%CI: 1.925-8.909), and postoperative bed rest time ≥ 5 d (OR=3.628, 95%CI: 1.710-7.697) were all independent risk factors for postoperative complications of lower limb DVT in patients with uterine fibroids (P<0.05); based on 7 independent risk factors, the nomogram early warning model of postoperative DTV in patients with uterine fibroids after laparoscopic excision was established. The results showed that age ≥60 years was 93 points, 85 points for preoperative complications, 93 points for general anesthesia, 74 points for operation time ≥2 h, 83 points for intraoperative pneumoperitoneum pressure ≥15 mmHg, 100 points for plasma D-dimer ≥500 ng/mL, and the postoperative bed rest time ≥5 days was 91 points. The model validation results showed that the C-index was 0.853 (95%CI: 0.822-0.884), and the predicted value of the calibration curve was basically the same as the measured value. Internally validated gynecological abdominal surgery patients were combined. The area under the ROC curve (AUC) of the risk nomogram model for lower extremity DVT was 0.832 (95%CI: 0.804-0.860). Conclusions：Age ≥60 years old, preoperative complications, general anesthesia, operation time≥ 2 h, intraoperative pneumoperitoneum pressure ≥15 mmHg, plasma D-dimer ≥500 ng/mL, and postoperative bed rest time ≥5 days were all independent risk factors for lower extremity DTV after laparoscopic myomectomy. The nomogram based on the above seven independent risk factors is helpful to predict the risk of lower extremity DTV after laparoscopic myomectomy. |
| |
| Keywords: | Uterine neoplasms Leiomyoma Laparoscopes Venous thrombosis Risk factors Nomogram |
|
| 点击此处可从《国际妇产科学杂志》浏览原始摘要信息 |
|
点击此处可从《国际妇产科学杂志》下载全文 |
|
