影响卵巢癌减灭术后下肢静脉血栓发生的相关因素分析

目的 探讨影响卵巢癌减灭术后下肢静脉血栓发生的相关因素.方法 将90例卵巢癌患者,按照术后是否发生下肢静脉血栓分为血栓组和非血栓组,分析2组患者术前相关参数、术中相关因素和术后相关参数.结果 单因素分析显示,体重指数、年龄、纤维蛋白原、血小板计数、血栓史、术中出血量和输血量、满意减瘤和卧床天数是卵巢癌减瘤术后下肢静脉血栓发生的高危因素.多因素分析显示,体重指数、血小板计数、纤维蛋白原和卧床天数是卵巢癌减瘤术后下肢静脉血栓发生的独立影响因素.结论 对于肥胖、血小板计数增高、高纤维蛋白原和术后长时间卧床的患者,应及时采取预防措施,防止术后发生下肢静脉血栓.     

人工关节置换术后下肢深静脉血栓形成的危险因素相关性分析

目的 分析人工关节置换患者术后深静脉血栓 （deep vein thrombosis,DVT） 形成的相关危险因素。方法 2008 年２月至 2012 年９月,114 例关节置换患者术前和术后第７天进行双下肢静脉 Duplex 彩色超声检查,观察 DVT 的形成情况,根据是否形成 DVT,分为 DVT 组和非 DVT 组,记录患者的相关临床因素,分析患者的临床因素与术后下肢深静脉血栓形成 （DVT） 的发生有无相关性。术后采用标准计量的低分子量肝素抗凝。本组男 46 例,女 68 例;年龄 24～85 岁,平均 （59.64±8.63） 岁。结果 术后发生血栓的患者 32 例,发生概率为 28%,其中 THA （total hip arthroplasty,THA） 15 例,发生概率为 18.9%,TKA （total knee arthroplasty,TKA） 17 例,发生概率为 48.6%。进行多因素的 logistic 回归分析表明：年龄≥65 岁、TG ≥1.7 mmol/L、全身麻醉、膝关节置换是关节置换术后 DVT 发生的危险因素 （P＜0.05）。结论 年龄高、体重大、TG 水平升高、膝关节置换、全身麻醉、有家族性 VTE 史、饮酒史等的患者发生 DVT 的风险较高。而年龄高、膝关节置换、全身麻醉及 TG ≥1.7 mmol/L 则是关节患者术后发生 DVT 的危险因素,需要引起临床医生的重视。     

外周血血小板计数及纤维蛋白原含量在上皮性卵巢癌诊治中的意义

[目的]探讨外周血血小板（PLT）计数及血浆纤维蛋白原（FIB）与上皮性卵巢癌生物学行为的关系。[方法]回顾性分析上皮性卵巢癌初次手术病例82例,并与同期收治的52例卵巢良性肿瘤作对照,比较两组术前血小板计数和纤维蛋白原含量。同时分析血小板计数和纤维蛋白原含量与上皮性卵巢癌生物学行为的关系。[结果]术前上皮性卵巢癌患者血小板计数增高者占52.44%,良性肿瘤中占11.54%;在上皮性卵巢癌中血浆纤维蛋白原增高者占53.66%,而良性肿瘤中占7.69%,差异均有统计学意义（P=0.000）。血小板计数与上皮性卵巢癌的FIGO分期、腹水、分化程度、是否行理想的肿瘤细胞减灭术有关（P〈0.05）,与CA125及病理类型无关。血浆纤维蛋白原与上皮性卵巢癌的各项临床病理因素均无关（P〉0.05）。单因素及多因素分析结果显示血小板计数及纤维蛋白原均与卵巢癌复发无关。[结论]血小板计数增高可能是反映上皮性卵巢癌浸润程度的指标。纤维蛋白原增高可能是卵巢癌的结果,其与血小板的关系有待于进一步研究。     

颅脑肿瘤患者术后下肢深静脉血栓相关危险因素分析

目的 探究颅脑肿瘤患者术后下肢深静脉血栓的相关危险因素。方法 选择颅脑肿瘤患者100例,依据术后DVT发生情况分为DVT组(17例),非DVT组(83例)。分析颅脑肿瘤患者术后DVT发生率,并对相关危险因素行单因素及多因素分析。结果 单因素分析显示：DVT组幕上肿瘤、术后有下肢功能障碍发生率均高于非DVT组,手术时间、卧床时间长于非DVT组,D-D、TC、TG水平高于非DVT组,PT长于非DVT组,有统计学差异(P<0.05)。多因素分析显示：肿瘤位置、术后下肢功能障碍、术中输血、肢体肿胀、术后感染、手术时间、卧床时间、PT、D-D、TC、TG是颅脑肿瘤术后DVT发生的独立危险因素(OR值≥1,且P<0.05)。结论 肿瘤位置、术后下肢功能障碍、术中输血、肢体肿胀、术后感染、手术时间、卧床时间、PT、D-D、TC、TG是颅脑肿瘤患者术后DVT发生的独立危险因素,临床可结合上述危险因素行针对性干预,以改善预后。     

妇科肿瘤术后并发下肢深静脉血栓21例分析

回顾性分析1984年1月至1999年12月间妇科肿瘤术后并发下肢深静脉血栓（DVT）21例患者的临床特点,诊断及治疗。认炽老年妇女,肥胖,经腹手术,手术时间长,术前及术中输血,术后应用止血药,妇科恶性肿瘤是DVT的高危因素,抗凝,祛聚,溶栓治疗对DVT有较好疗效。     

口腔颌面部肿瘤患者术后发生下肢深静脉血栓的相关危险因素分析

目的 分析口腔颌面部肿瘤患者术后发生下肢深静脉血栓的相关危险因素.方法 选取口腔颌面部肿瘤术后发生下肢深静脉血栓患者52例作为发生组,并以1:1配比选取同期口腔颌面部肿瘤术后未发生下肢深静脉血栓患者52例作为未发生组,收集2组年龄、性别、体质量指数(BMI)是否超重、术后D-二聚体、术后纤维蛋白原(FIB)等临床信息,...     

Caprini和Rogers血栓风险评估模型在胸外科肺癌患者围手术期应用的验证研究

目的：对Caprini和Rogers血栓风险评估模型在胸外科肺癌患者围术期筛查静脉血栓栓塞症（Venous Thromboembolism, VTE）高风险的适用性进行分析,以验证其有效性。方法：根据入排标准纳入2015年3月至2017年3月在四川省肿瘤医院胸外科接受手术治疗的肺癌患者,术后未预防性抗凝处理。所有患者围术期行双下肢血管彩超检查,怀疑肺血管栓塞者行胸CT检查,前瞻性收集临床和实验室相关指标。以Caprini和Rogers血栓风险评估量表对所有患者进行血栓风险评分。分别分析Caprini和Rogers评分不同层级组之间术后VTE发生率、危险因素、实验室指标的差异。结果：152例肺癌患者入选本研究,术后深静脉血栓（Deep Vein Thrombosis, DVT）发生率25%（38/152）,无肺栓塞发生。全组患者Caprini评分为8～15分,均至少为VTE高风险层级,其中高危组（5-8分）66例,极高危组（＞9分）86例;两组DVT发生率为26.6% vs.21.3%（P=0.46）,差异无统计学意义。全组Rogers评分9-18分,其中低危组（7-10分）67例,中高危组（＞10分）85例;低危组与中高危组DVT发生率为25.4% vs.22.1%（p=0.64）,差异无统计学意义。Caprini评分高危组与极高危组之间和Rogers评分低危组与中高危组之间在DVT危险因素吸烟指数、血型构成、合并COPD病史、组织学类型、VATS、手术时间、术后卧床时间、病理学分期的差异均无统计学意义（p＞0.05）;在围术期各时点的凝血指标及NLR（中性-淋巴细胞比值）的差异亦无统计学意义。结论：Caprini血栓风险评估模型评价胸外科肺癌手术患者易评为VTE高风险人群,对预防VTE具有积极的指导意义,但Caprini和Rogers血栓风险评估模型对胸外科肺癌患者围术期VTE风险层级评估的有效性尚不确切,应探索建立符合我国肺癌人群特质的胸外科血栓风险评估量表体系。     

全髋人工关节置换术后下肢深静脉血栓的早期诊断

目的探索全髋人工关节置换患者围手术期D-二聚体（D—dimer,DD）、血浆纤维蛋白原（fibrinogen,FIB）和纤维蛋白降解产物（fibrin degradation product,FDP）在下肢深静脉血栓形成中的诊断价值和各自的敏感性与特异性。方法对2008年6月至2012年6月,在我科行全髋人工关节置换（total hip artbroplastic,THA）的168例患者分别于术前和术后第1、3、7天进行血浆DD、FIB、FDP的检测;术前和术后第3、7天应用彩色多普勒超声血流探测仪检测患者双下肢深静脉血栓（deep vein thrombosis,DVT）的形成。按照彩色多普勒超声血流探测仪检测结果将患者分为DVT阳性组和DVT阴性组,分析DD、FIB、FDP对于全髋人工关节置换术后DVT形成的诊断价值和各自的敏感性与特异性。结果术后32例患者发生DVT,占19．1％。在检测的3个指标中,DD、FDP的受试者工作特征曲线（receiver operating characteristic,ROC）下面积分别为81．8％（P=0．002）和68．4％（P=0．009oFIB曲线下的面积仅为56．3％（P=0．31o结论DD和FDP在全髋人工关节置换术后DVT的形成中有诊断意义。FIB对于在全髋人工关节置换术后DVT形成中的诊断意义较低。术后及时检测DD和FDP可以及时发现DVT,避免肺动脉血栓栓塞症（pulmonarvthromboembolism,PTE）的发生。     

晚期上皮性卵巢癌术前新辅助化疗的临床总结

探讨晚期卵巢癌能否行手术治疗的预测因素及新辅助化疗在晚期卵巢癌中的临床价值。方法:回顾性分析了大连医科大学附属第一医院1996年1月至2008年12月收治的Ⅲ～Ⅳ期晚期卵巢癌病例92例,其中18例接受新辅助化疗（NAC组）,74例接受初次手术（PCS组）。结果:使初次肿瘤细胞减灭术满意率降低的因素:伴有合并症（P=0.022）;初次治疗时存在胸腔积液（P=0.011）;CA125>1 000 U/L（P=0.030）;有肝、肺转移的Ⅳ期患者（P=0.031）。新辅助化疗的总有效率为66.7%。新辅助化疗可以提高肿瘤细胞减灭术的满意率（P=0.022）,缩短引流管置留天数（P=0.011）,减少腹水量（P=0.005）、术中出血量（P=0.048）,但在手术时间、输血量、平均住院天数、患者生存时间方面,NAC组与PCS组的差异无统计学意义（P>0.05）。结论:伴有合并症、胸腔积液、CA125>1 000 U/L、临床分期为Ⅳ期、表现为肝、肺转移的患者适合新辅助化疗。新辅助化疗可以提高肿瘤细胞减灭术的满意率,减少术中、术后并发症,可能会改善患者预后。      

胰腺癌术后应用低分子肝素钙预防深静脉血栓的临床价值

目的:探讨低分子肝素钙预防胰腺癌术后深静脉血栓的临床价值.方法:选取胰腺癌患者180例,根据术后是否应用低分子肝素钙随机分为治疗组和对照组.分别在治疗前后比较两组患者组织型血浆酶原激活剂(t-PA)、血浆酶原激活抑制剂(PAI)、纤维蛋白原(FIB)及D-二聚体(D-D)的差异,观察有无发生深静脉血栓(DVT)及术后出血等不良反应,并对DVT患者进行危险因素分析.结果:对照组、治疗组术后PAI、FIB以及D-D水平均较术前低,t-PA水平较术前高;治疗组术后PAI、FIB以及D-D水平均较对照组术后低,t-PA水平较对照组高,差异均有统计学意义(分别P<0.05及P<0.01).治疗组DVT、肺栓塞、心肌梗死发生率低于对照组,差异有统计学意义(P<0.05);心源性猝死和术后出血发生率两组差异无统计学意义(P>0.05).多因素分析结果显示,肥胖、既往冠心病、下肢静脉曲张是导致胰腺癌术后易患DVT的独立危险因素(P<0.05).结论:早期应用低分子肝素钙对于预防胰腺癌术后伴发DVT安全且疗效肯定.     

Low molecular weight heparin for venous thromboembolism prophylaxis in urologic oncologic surgery

OBJECTIVES: This is a prospective study in the use of low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis in the previously unstudied subset of patients undergoing elective urologic cancer surgery. METHODS: Thirty-eight patients undergoing elective urologic surgery were studied. Thirty-six had urologic malignancies. Pre-operative risk factors for venous thromboembolic disease were recorded. All patients received LMWH (dalteparin, Fragmin; Pharmacia, Stockholm, Sweden) subcutaneously on a daily basis beginning 1-2 hr before surgery and lasting for 3-7 days. Postoperative physical examination was used to check for clinical evidence of deep venous thrombosis (DVT). Clinical parameters such as physical examination and radiological testing were used to assess for evidence of DVT. Other data included intraoperative blood loss, transfusion requirements, postoperative bleeding complications, postoperative hematocrit and coagulation profiles, and local complications related to the subcutaneous injection of the LMWH. RESULTS: All patients completed the prophylaxis protocol. None developed DVT. Mean intraoperative blood loss was 735 mL and 12 patients received an average of 1 unit of blood transfusion. No unusual hemorrhagic events were noted intra- or post-operatively. No reactions to the LMWH were noted. Average hematocrit of postoperative day 3 was 30.7 and platelet count and coagulation profiles remained normal postoperatively. CONCLUSIONS: Low molecular weight heparins appear promising for DVT prophylaxis in high-risk urology patients.     

Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Urologic Oncologic Surgery

Objectives: This is a prospective study in the use of low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis in the previously unstudied subset of patients undergoing elective urologic cancer surgery.

Methods: Thirty-eight patients undergoing elective urologic surgery were studied. Thirty-six had urologic malignancies. Pre-operative risk factors for venous thromboembolic disease were recorded. All patients received LMWH (dalteparin, Fragmin; Pharmacia, Stockholm, Sweden) subcutaneously on a daily basis beginning 1-2 hr before surgery and lasting for 3-7 days. Postoperative physical examination was used to check for clinical evidence of deep venous thrombosis (DVT). Clinical parameters such as physical examination and radiological testing were used to assess for evidence of DVT. Other data included intraoperative blood loss, transfusion requirements, postoperative bleeding complications, postoperative hematocrit and coagulation profiles, and local complications related to the subcutaneous injection of the LMWH.

Results: All patients completed the prophylaxis protocol. None developed DVT. Mean intraoperative blood loss was 735 mL and 12 patients received an average of 1 unit of blood transfusion. No unusual hemorrhagic events were noted intra- or post-operatively. No reactions to the LMWH were noted. Average hematocrit of postoperative day 3 was 30.7 and platelet count and coagulation profiles remained normal postoperatively.

Conclusions: Low molecular weight heparins appear promising for DVT prophylaxis in high-risk urology patients.     

上皮性卵巢癌初次肿瘤细胞减灭术后复发情况及影响因素分析

目的:研究上皮性卵巢癌初次肿瘤细胞减灭术后复发情况以及影响因素分析,旨在为降低上皮性卵巢癌初次肿瘤细胞减灭术后复发提高患者术后生存质量提供有效的理论依据。方法:采用回顾性方法分析我院在2008年1月至2012年12月期间进行肿瘤细胞减灭术治疗的186例上皮性卵巢癌患者的临床资料,术后根据患者复发情况将患者分成复发组与未复发组。观察两组患者年龄、组织学类型、化疗方式、新辅助化疗、临床分期、组织分级、残余病灶、腹水、术前HE4、术后2月CA125、淋巴结切除之间的差异,同时分析影响上皮性卵巢癌初次肿瘤细胞减灭术后复发的独立危险因素。结果:随访5年,复发患者有78例,复发率为41.94%,未复发患者108例;复发组与未复发组患者在年龄、组织学类型、化疗方式、新辅助化疗等因素中比较无差异（P＞0.05）,在临床分期、组织分级、残余病灶、腹水、术前HE4、术后2月CA125、淋巴结切除中存在明显差异（P＜0.05）;经Logistic回顾分析证明,临床分期、残余病灶、腹水、术前HE4、淋巴结切除是临床上皮性卵巢癌患者初次肿瘤细胞减灭术后复发的独立危险因素［OR=9.786（3.484~27.493）、OR=8.199（4.431 ~15.172）、OR=9.143（3.975~21.031）、OR=9.337（4.593~18.983）、OR=11.917（6.440~22.053）］。结论:上皮性卵巢癌患者经初次肿瘤细胞减灭术治疗后,复发率为41.94%左右,而影响患者术后复发的独立危险因素为临床分期、残余病灶、腹水、术前HE4、淋巴结切除等,临床上可针对这些因素进行干预降低临床术后复发率,提高患者生活质量。     

Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients

Background

The prevalence of deep venous thrombosis (DVT) in patients with gastric cancer before surgery is unknown. This study aimed to clarify the risk factors for DVT of the lower extremities in patients with gastric cancer before surgery and to evaluate the usefulness of ultrasonographic screening for prevention of postoperative pulmonary thromboembolism (PTE).

Methods

Patients who had undergone lower-extremity venous ultrasonography before surgery for gastric cancer were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify the predictors of DVT before surgery. Perioperative management of patients with DVTs and the incidence of postoperative PTE were investigated.

Results

Of the total 1140 patients, 86 had DVT preoperatively. On univariate analysis, the incidence of DVT was significantly higher with: female sex; age ≥80 years; PS ≥ 1 (vs. PS = 0); stage IV (vs. stages I–III); history of preoperative chemotherapy; and the presence of a central venous catheter (CVC). Multivariate logistic regression analysis demonstrated that sex, age ≥80 years, PS ≥ 1, history of preoperative chemotherapy, and the presence of CVC were significantly correlated with DVT before surgery. Postoperative PTE occurred in 2 patients with proximal DVT. No patients in whom DVT was not detected developed PTE.

Conclusions

Female sex, older age, worse PS, the presence of CVC, and a history of preoperative chemotherapy were the independent risk factors for DVT. Routine lower-extremity venous ultrasonographic screening is useful for prevention of PTE because it can identify patients at high or low risk for PTE.

     

Optimal strategy of gamma knife radiosurgery for craniopharyngiomas

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently complicates the postoperative course of primary malignant brain tumor patients. Thromboprophylactic anticoagulation is commonly used to prevent VTE at the risk of intracranial hemorrhage (ICH). We extracted all patients who underwent craniotomy for a primary malignant brain tumor from the National Surgical Quality Improvement Program (NSQIP) registry (2005–2015) to perform a time-to-event analysis and identify relevant predictors of DVT, PE, and ICH within 30 days after surgery. Among the 7376 identified patients, the complication rates were 2.6, 1.5, and 1.3% for DVT, PE, and ICH, respectively. VTE was the second-most common major complication and third-most common reason for readmission. ICH was the most common reason for reoperation. The increased risk of VTE extends beyond the period of hospitalization, especially for PE, whereas ICH occurred predominantly within the first days after surgery. Older age and higher BMI were overall predictors of VTE. Dependent functional status and longer operative times were predictive for VTE during hospitalization, but not for post-discharge events. Admission two or more days before surgery was predictive for DVT, but not for PE. Preoperative steroid usage and male gender were predictive for post-discharge DVT and PE, respectively. ICH was associated with various comorbidities and longer operative times. This multicenter study demonstrates distinct critical time periods for the development of thrombotic and hemorrhagic events after craniotomy. Furthermore, the VTE risk profile depends on the type of VTE (DVT vs. PE) and clinical setting (hospitalized vs. post-discharge patients).     

宫颈癌腹腔镜手术治疗的有效性及术后患者手术部位感染的影响因素

目的 分析宫颈癌腹腔镜手术治疗的有效性及术后患者手术部位感染的影响因素.方法 选取宫颈癌患者81例,均行腹腔镜手术治疗,统计临床效果、手术部位感染发生率,收集患者年龄、体质量指数(BMI)、是否绝经、宫颈癌分期、是否多发肿瘤、手术时间等资料信息,分析术后手术部位感染的影响因素.结果 腹腔镜手术治疗总有效率为90.12％...     

宫颈癌根治术后并发肠梗阻的危险因素分析

目的 探讨宫颈癌根治术后发生肠梗阻的危险因素。方法 回顾性分析2012年6月—2017年6月149例宫颈癌根治术后并发肠梗阻患者的临床资料,与同期行该手术但未发生肠梗阻的2 436例患者资料进行对比,分析并发肠梗阻的危险因素。 结果 肠梗阻的发生与患者的年龄、手术时间、术后血钾水平、术后禁食时间、术前盆腹腔手术史、BMI、手术入径、术后感染、术后伴发腹腔积液有关（P<0.05）。其中盆腹腔手术史、术后禁食时间长、术后血钾水平低、手术消耗时间长是独立危险因素。而在手术出血量、术后患者血红蛋白水平、术中是否输血方面两组差异无统计学意义（P>0.05）。结论 缩短手术时间、鼓励患者术后尽早进食,维持术后血钾水平是预防宫颈癌术后发生肠梗阻的有效措施。     

Significance of postoperative CA-125 decline after cytoreductive surgery in stage IIIC/IV ovarian cancer

Objective

The purpose of this study was to evaluate whether the decline in serum CA-125 levels following primary cytoreductive surgery prior to starting adjuvant chemotherapy has a prognostic value in patients with stage IIIC/IV ovarian carcinoma.

Methods

A retrospective review was conducted of all patients with stage IIIC/IV ovarian carcinoma who underwent primary cytoreductive surgery followed by platinum-based chemotherapy from 1994 to 2007. Demographic, pathologic, treatment, and survival data were collected. Patients were included if serum CA-125 levels were drawn preoperatively and within one week prior to their first chemotherapy cycle, and whose postoperative CA-125 level declined. Percentage decline was calculated, and was compared with standard statistical tests in groups by 25% declination intervals.

Results

Of the 112 stage IIIC/IV patients, 81 (72.3%) met the above inclusion criteria. The median time from surgery to postoperative CA-125 sampling was 16 days (range: 7-42). A ≥75% decline was associated with a median progression-free survival (PFS) of 25 months (95% CI=0-63). This was significantly longer when compared with each of the other 25% interval groups. After multivariate analysis, independent prognostic factors included a ≥75% decline in CA-125 levels after surgery and the presence of residual tumor. Age, grade, histology, and preoperative CA-125 levels were not statistically significant factors.

Conclusion

A ≥75% decline in serum CA-125 serum levels from primary cytoreductive surgery to the start of adjuvant chemotherapy has independent prognostic value for PFS in patients with stage IIIC/IV ovarian carcinoma.     

溶栓与单纯抗凝初始性治疗术前合并中高危肺栓塞癌症患者的疗效比较

目的 比较对术前合并中高危肺栓塞的癌症患者,初始治疗采用溶栓与单纯抗凝治疗的疗效和出血风险.方法 回顾性分析行手术治疗的26例中高危肺栓塞的癌症患者.比较术前采用单纯抗凝和溶栓治疗,患者右心功能指标、术前准备时间、住院天数、肺栓塞治疗疗效、围术期出血率、术后再发栓塞事件等差异.结果 溶栓组患者右室舒张横径等右心功能指标较抗凝组更早改善;此外,肺栓塞治疗疗效、术前准备时间、住院天数、术后血栓事件,溶栓组优于单纯抗凝组,差异均有统计学意义(P＜0.05).而两者围术期出血率比较,差异无统计学意义.结论 对于术前合并中高危肺血栓栓塞症的癌症患者,初始治疗采用溶栓对比单纯抗凝,能更早改善右心功能指标,缩短患者的术前准备时间,为患者早日手术创造时机,缩短患者的住院天数,且不增加患者围术期出血风险,可以更好的预防患者术后再发血栓栓塞事件,是安全有效的.