肿瘤细胞减灭术加腹腔热灌注化疗围手术期静脉血栓栓塞症的危险因素及防治技术

目的分析肿瘤细胞减灭术(cytoreductive surgery, CRS)加腹腔热灌注化疗(hyperthermic intraperitonealchemotherapy,HIPEC)围手术期静脉血栓栓塞症(venousthromboembolism, VTE)的独立危险因素,探索VTE综合防治技术。方法分析CRS+HIPEC治疗患者的VTE风险,通过单因素和多因素分析筛选VTE独立危险因素;分析物理治疗加药物干预对防治VTE的疗效。结果820例腹膜癌患者行CRS+HIPEC治疗,围手术期发生VTE者14例(1.7%),其中6例(0.7%)为无临床症状型VTE,8例(1.0%)发生9个临床症状型VTE事件。未发生VTE相关死亡。单因素分析提示高龄(P=0.043)、超重(P=0.023)、VTE既往史(P=0.001)、术前VTE(P=0.008)、脉管瘤栓(P=0. 0 3 6)是V T E事件的高危险因素;多因素分析显示V T E既往史(O R=1 3. 7 4 4,95%CI:2.391～64.455)、脉管瘤栓(OR=5.858, 95%CI:1.028～33.387)是V T E事件的独立危险因素。结论VTE既往史、脉管瘤栓是腹膜癌CRS+HIPEC围手术期VTE的独立危险因素,以物理预防为主的综合防治技术可有效预防VTE。

Risk Factors and Prevention of Perioperative Venous Thromboembolism After Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy: An Analysis of 820 Cases

Objective To analyze the independent risk factors for perioperative venous thromboembolism (VTE) after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy(HIPEC), and to develop an integrated VTE prevention strategy. Methods The comprehensive database of CRS+HIPEC was first systematically investigated to analyze the risk factors for VTE, and univariate and multivariate analyses were conducted to screen independent risk factors for VTE. An integrated VTE prevention strategy combining physiotherapy and pharmaceutical treatment was developed and applied to the patients. Results Among the 820 patients treated with CRS+HIPEC in the database, 14(1.7%) patients developed VTE in the perioperative period, including 6(0.7%) patients with asymptomatic VTE events and 8(1.0%) patients with 9 symptomatic events. No VTE-related death occurred. Univariate analysis revealed 5 high risk factors: old age(P=0.043), overweight(P=0.023), previous VTE-history(P=0.001), preoperative VTE(P=0.008) and vascular tumor thrombus(P=0.036). Multivariate analysis confirmed two independent risk factors: previous VTE history(OR=13.744, 95%CI: 2.391-64.455) and vascular tumor thrombus(OR=5.858, 95%CI: 1.028-33.387). Conclusion Previous VTE history and vascular tumor thrombus are independent risk factors for peritoneal cancer(PC) patients after CRS+HIPEC. Physiotherapy-based integrated prevention and treatment strategy could help prevent VTE.