妇科肿瘤合并急性下肢深静脉血栓形成14例临床分析

目的:研究妇科肿瘤合并急性下肢深静脉血栓(DVT)形成的危险因素、临床特点和诊治方法。方法:回顾性分析我院1 4例妇科肿瘤合并急性下肢DVT患者的临床资料。结果:1 4例中4例恶性肿瘤,3例发展为肺栓塞。1 3例经彩超检查确诊。9例手术取栓,其中4例妇科手术同时外科取栓治疗;5例保守治疗。1 3例治疗后好转出院,1例死亡。结论:妇科肿瘤合并DVT应引起充分重视,彩超检查有助于DVT的诊断。急性DVT保守或手术治疗均有效。如DVT与妇科肿瘤有关,可在妇科手术同时行取栓术,联合抗凝、溶栓、祛聚、扩血管等综合治疗,防止血栓再发和促进后期再通。对有高危因素者手术前后应预防性应用抗凝剂。     

妇科肿瘤术后并发深静脉血栓29例分析

目的探讨妇科肿瘤术后并发深静脉血栓(deep venous thrombosis,DVT)的诊治及预防.方法回顾性分析29例妇科肿瘤术后并发DVT患者的临床资料.结果本组恶性肿瘤25例,占86.2%,平均年龄56.8岁,平均体重指数27.9.经血浆D-二聚体检测并结合静脉彩超检查,确诊后采用全身或者局部抗凝、溶栓等药物治疗或手术取栓治疗;并发肺动脉栓塞(pulmonary thromboembolism,PE)患者放置临时性下腔静脉滤器(inferior vena cava filter,IVCF)预防致死性PE,效果满意.结论恶性肿瘤、老年人、肥胖是妇科肿瘤术后DVT的高危因素,血浆D-二聚体检测结合静脉彩超可协助确诊,围手术期应积极预防DVT的发生,合理应用药物、介入和手术治疗可有效防治DVT.     

妇科肿瘤术后并发下肢深静脉血栓24例分析

目的：探讨妇科肿瘤患者术后并发下肢深静脉血栓形成（DVT）的原因、诊断治疗要点及预防措施。方法：回顾性分析24例妇科术后DVT的临床特点及诊断、治疗的方法。结果：发生DVT的高危因素是盆腔恶性肿瘤、老年妇女、血粘度增高、合并高血压、糖尿病及术后常规应用止血药等。治疗采用肝素、小剂量尿激酶、低分子右旋糖酐及复方丹参等，取得满意效果。结论：对有DVT高危因素的妇科肿瘤患者，手术前后应加强预防措施。     

妇科腹腔镜术后深静脉血栓的研究进展

腹腔镜在妇科手术中的应用范围不断扩大,检索有关腹腔镜术后发生下肢深静脉血栓(DVT)临床研究的国外文献,一些研究认为,腹腔镜手术引起DVT的原因除与患者本身的高危因素,如老年、恶性肿瘤、肥胖等相关外,手术本身的特殊性,如气腹、体位等也可造成血管壁损伤和静脉扩张淤血,可能导致DVT的发生.也有一些临床研究认为,与开腹手术相比,腹腔镜手术是安全的,并不会增加DVT.相应的预防措施,包括早期活动、物理治疗及药物治疗.     

妇科腹腔镜术后深静脉血栓的研究进展

腹腔镜在妇科手术中的应用范围不断扩大，检索有关腹腔镜术后发生下肢深静脉血栓（DVT）临床研究的国外文献。一些研究认为。腹腔镜手术引起DVT的原因除与患者本身的高危因素，如老年、恶性肿瘤、肥胖等相关外，手术本身的特殊性，如气腹、体位等也可造成血管壁损伤和静脉扩张淤血，可能导致DVT的发生。也有一些临床研究认为．与开腹手术相比，腹腔镜手术是安全的，并不会增加DVT。相应的预防措施，包括早期活动、物理治疗及药物治疗。     

妇科肿瘤术后并发深静脉血栓的诊治与预防

目的 探讨妇科肿瘤术后并发下肢深静脉血栓（ＤＶＴ）的诊断治疗要点及预防措施。方法回顾性分析１１例妇科ＤＶＴ患者和１８例有ＤＶＴ倾向患者的临床特点及诊断、治疗和预防的方法。结果 发生ＤＶＴ的高危因素为中老年妇女、肥胖、原发病多为贫腔恶性肿瘤,特别是子宫内膜癌。辅助诊断方法以彩色多普勒血流显像为最佳。治疗采用肝素或低分子肝素事速避凝抗凝治疗,均取得较好效果。结论 中老年、肥胖的肿瘤患者,特别是恶性肿瘤     

妇科肿瘤术后并发下肢深静脉血栓的预防

深静脉血栓是外科术后常见并发症之一。国外报道，外科术后深静脉血栓（deep venous thrombosis，DVT）的发生率为30％-50％，而在妇科肿瘤术后血栓形成发生率达7％-45％。而我国目前仍无确切的统计数字，但鉴于血栓形成可引起肺栓塞及下肢功能障碍，故对妇科肿瘤患者术后DVT的预防十分重要。本文对我院妇科肿瘤术后DVT的预防情况分析报道如下。     

妇科腹部术后穴位按摩预防深静脉血栓的探讨

深静脉血栓是手术后常见的并发症 ,由于血栓脱落引起肺栓塞致使术后并发症的发生率和死亡率亦升高 ,故对腹部手术后深静脉血栓的预防应给予高度重视 ,特别是高危患者采取一些有效的预防措施避免或减少深静脉血栓尤为重要。我们采用无创伤穴位按摩预防腹部术后深静脉血栓 ,取得了良好效果 ,现报道如下。1　资料与方法1.1研究对象2 0 0 1年 1月至 2 0 0 2年 9月我院收治的因妇科疾患行剖腹手术患者 2 6 0例 ,其中卵巢癌 12例 ,子宫内膜癌 12例 ,子宫肌瘤 95例 ,卵巢良性肿瘤 2 8例 ,子宫内膜异位症 4 4例。患者平均年龄 (5 1 6± 5 4 )岁。手…     

妇科盆腔手术后下肢深静脉血栓形成的早期诊断

目的：探讨妇科盆腔手术后下肢深静脉血栓形成的早期诊断方法。方法：采用D-二聚体(D-dimer)与彩色多普勒超声对141例妇科盆腔手术后患者进行检查,对其中超声诊断的4例下肢静脉血栓患者行下肢静脉造影。结果：彩色多普勒超声检查出小腿静脉血栓22例,4例行下肢静脉造影的结果与超声诊断相符。D-dimer的敏感性为95．5%,特异性为60．5%,准确性为66%,阳性预测值为30．8%,阴性预测值为98．6%。结论：D-dimer联合彩色多普勒超声检查可作为妇科盆腔手术后下肢深静脉血栓形成的早期诊断方法。     

妇科盆腔手术后下肢深静脉血栓治疗及转归的临床研究

目的:探讨妇科盆腔手术后下肢深静脉血栓(DVT)的治疗方法及转归。方法:依据治疗程度将31例妇科盆腔手术后下肢DVT患者分为治疗充分组(17例)与治疗不充分及未治疗组(14例),回顾性分析两组患者的临床特点、治疗方法及转归。结果:①31例患者中有3例患者术后发生肺栓塞(PTE),发病率为9.7%;②治疗充分组患肢酸痛乏力缓解时间及患肢水肿或压痛缓解时间明显早于未治疗及治疗不充分组(P<0.05);③半年后血栓形成后综合征(PTS)发生率,两组差异无显著性(P>0.05);④复查双下肢静脉超声,治疗充分组血栓完全溶解率(87.5%)明显高于未治疗及治疗不充分组(38.5%)(P<0.05)。结论:妇科盆腔手术后DVT可继发PTE及PTS;抗凝治疗是DVT的有效治疗方法;及时、充分治疗是祛除血栓,预防DVT严重并发症的有效方法。     

Prevention of postoperative venous thromboembolism by external pneumatic calf compression in patients with gynecologic malignancy

One hundred seven patients undergoing major surgery for gynecologic malignancy participated in a controlled trial evaluating the effectiveness of pneumatic calf compression in the prevention of postoperative deep venous thrombosis and pulmonary embolism. External pneumatic calf compression was applied intraoperatively and for five postoperative days. All patients were prospectively screened for deep venous thrombosis with impedance plethysmography and 125I-fibrinogen leg counting. Deep venous thrombosis and/or pulmonary emboli were detected in 18 of 52 control group patients (34.6%) whereas in seven of 55 (12.7%) of those treated with external pneumatic calf compression (P less than .005). External pneumatic calf compression was most effective during the first five days postoperatively and also reduced the incidence of deep venous thrombosis in patients at highest risk. When applied during surgery and for five days postoperatively, external pneumatic calf compression significantly reduces the incidence of postoperative venous thrombosis.     

Fibrinolytic treatment of postoperative deep venous thrombosis.

Eleven patients with deep venous thrombosis were treated with streptokinase. Lysis of thrombi and prevention of pulmonay embolism were achieved in eight patients. Bleeding from the operative wound necessitated transfusions in seven patients. Fibrinolytic treatment of deep venous thrombosis lyses the floating portion of the thrombi. Protection against pulmonary embolism may be expected. The fibrinolytic effect of streptokinase is rapid; its value can be answered only by follow-up examinations.     

Prevention of venous thromboembolism in gynecologic oncology surgery

Gynecologic oncology patients are at a high-risk of postoperative venous thromboembolism and these events are a source of major morbidity and mortality. Given the availability of prophylaxis regimens, a structured comprehensive plan for prophylaxis is necessary to care for this population. There are many prophylaxis strategies and pharmacologic agents available to the practicing gynecologic oncologist. Current venous thromboembolism prophylaxis strategies include mechanical prophylaxis, preoperative pharmacologic prophylaxis, postoperative pharmacologic prophylaxis and extended duration pharmacologic prophylaxis that the patient continues at home after hospital discharge. In this review, we will summarize the available pharmacologic prophylaxis agents and discuss currently used prophylaxis strategies. When available, evidence from the gynecologic oncology patient population will be highlighted.     

Defining practice patterns in gynecologic oncology to prevent pulmonary embolism and deep venous thrombosis

OBJECTIVE: The goal of venous thromboembolism (VTE) prophylaxis is to reduce the morbidity and mortality associated with the development of a deep venous thrombosis (DVT) or pulmonary embolism (PE). Because women with gynecologic cancers are at high risk to develop VTE, we sought to determine the present practice patterns of gynecologic oncologists regarding their use of VTE prophylaxis. METHODS: 1073 members of the Society of Gynecologic Oncologists (SGO) were mailed surveys that asked about preferred methods to prevent the development of VTE after gynecologic oncology surgery. Data were collected by online member entry and return mail. Frequency distributions were calculated and nonparametric test used for comparisons. RESULTS: 343/1073 (34%) of SGO members and fellows responded. 142/343 (42%) preferred double prophylaxis consisting of external pneumatic compression (EPC) and an anticoagulant while 41% (n=141) preferred EPC with no additional anticoagulation. Of respondents choosing any anticoagulant, 40% preferred Enoxaparin pre- and/or postoperatively. Ovarian cancer patients were perceived by respondents to have the highest risk of developing a postoperative PE. CONCLUSIONS: Most respondents agree that women with gynecologic cancers undergoing major surgery should receive VTE prophylaxis, though there is not agreement as to which method is optimal. While 42% of members preferred double prophylaxis, 41% chose no additional measures other than EPC. Randomized studies in gynecologic oncology should be initiated in the United States to determine the optimal practice pattern.     

Cost-effectiveness of deep venous thrombosis prophylaxis in gynecologic oncology surgery

OBJECTIVE: To estimate the cost-effectiveness of preventive strategies for deep vein thrombosis (DVT) in patients undergoing surgery for gynecologic cancer. METHODS: A model was constructed to estimate the costs and outcomes associated with the use of external pneumatic compression, unfractionated heparin, and low molecular weight heparin in women with cervical, endometrial, and ovarian cancer. We estimated cost per DVT prevented, per fatal pulmonary embolus (PE) prevented, and per life-year saved. Probability estimates for various outcomes and efficacies were obtained from the literature, using data specific for gynecologic patients when available. RESULTS: Cost-effectiveness estimates ranged from $27 per life-year saved for a 55-year-old endometrial cancer patient to $5132 per life-year saved for a 65-year-old with ovarian cancer. Although low molecular weight heparin and unfractionated heparin were cost-effective compared with no prophylaxis, each was less effective than external pneumatic compression in the base case. The results of the analysis were sensitive to assumptions about the relative risk of DVT, the life expectancy of the patient, the costs of future treatment, and the relative effectiveness of the different strategies: If unfractionated heparin or low molecular weight heparin is at least 2-3% more effective than external pneumatic compression, then the incremental cost per life-year of either would be less than $50,000 compared with external pneumatic compression. CONCLUSION: Prophylaxis of DVT is cost-effective in terms of life-years gained even for patients with relatively short life expectancies, such as ovarian cancer patients. External pneumatic compression appears to be the most cost-effective strategy under our baseline assumptions, but further studies in gynecologic cancer are needed to validate our conclusions.     

术后深静脉血栓与卵巢癌预后的相关性分析

目的:探讨卵巢癌术后深静脉血栓(DVT)对卵巢癌患者无病生存时间(DFS)的影响。方法:回顾分析2009年至2014年于华中科技大学同济医学院附属同济医院初诊为卵巢癌并行手术治疗的103例患者的临床资料。采用独立样本T检验比较卵巢癌术后并发深静脉血栓和未发深静脉血栓组卵巢癌患者的临床病理特征。采用单因素和多因素Cox回归分析影响卵巢癌术后无病生存时间(DFS)的独立因素;绘制受试者工作特征(ROC)曲线,分析术后深静脉血栓对卵巢癌DFS的预测能力,并确定最佳临界值;采用Kaplan-Meier曲线分析法,对卵巢癌患者进行生存分析。结果:103例患者中,DVT组25例,无DVT组78例。多因素分析提示,年龄、体重指数(BMI)、手术病理分期及是否术后并发DVT(P0.05)与卵巢癌的DFS相关。DVT组和无DVT组卵巢癌患者的中位DFS比较,差异有统计学意义(P=0.03)。结论:卵巢癌患者术后合并DVT是一项重要的不良预后因素;是否发生DVT可作为卵巢癌患者DFS的独立预测指标,可与年龄、BMI共同预测患者的预后。     

Prevention and treatment of venous thromboembolism in pregnancy

During pregnancy, women have a 4- to 5-fold increased risk of thromboembolism. Candidates for anticoagulation in pregnancy include women with current thrombosis, a history of thrombosis, risk factors for postpartum thrombosis, and some women with thrombophilia and a history of poor pregnancy outcome. Although, there are no large trials of anticoagulants in pregnancy and recommendations for their use are based on case series and the opinion of experts, observational studies demonstrate the benefit of heparins in reducing the risk of recurrent thromboembolism in pregnancy. A practical approach to the prevention and treatment of thromboembolism in pregnancy is outlined.