Martino Martin A, Borges Elana, Williamson Eva, Siegfried Sylvia, Cantor Alan B, Lancaster Johnathan, Roberts William S, Hoffman Mitchel S
Department of Obstetrics and Gynecology, The Cancer Center at Lehigh Valley Hospital, Allentown, Pennsylvania 18104, USA.
Obstet Gynecol. 2006 Mar;107(3):666-71. doi: 10.1097/01.AOG.0000200046.28199.ae.
To estimate the incidence and prognostic significance of postoperative pulmonary embolism after gynecologic oncology surgery.
All patients who underwent gynecologic oncology surgery from June 2001 to June 2003 and received venous thromboembolism prophylaxis with only intermittent pneumatic compression and early ambulation were identified from our database. Patients were grouped by procedure (major/minor abdominal or nonabdominal surgery), diagnosis (malignant/nonmalignant), and cancer subtype. Groups were compared by chi2 analysis and logistic regression. Survival was studied with the Kaplan-Meier method and Mantel-Byar test.
A total of 1,373 surgical patients were identified over the 2-year period, including 839 major abdominal surgery cases and 534 minor abdominal surgery or nonabdominal surgery cases. Of the 839 patients, 507 had a diagnosis of cancer, and 332 were benign. The incidence of pulmonary embolism among cancer patients undergoing major abdominal surgery was 4.1% (21/507) compared with 0.3% (1/332) among patients undergoing major abdominal surgery with benign findings (P < .001, odds ratio [OR] 13.8, 95% confidence interval [CI] 1.9-102.1). The incidence of pulmonary embolism among patients undergoing minor/nonabdominal surgery was 0.4% (2/536). Cancer diagnosis and age more than 60 years were identified as risk factors for pulmonary embolism (P = .009, OR 0.31, 95% CI 0.13-0.74). One-year survival for patients with and those without pulmonary embolism were 48.0% +/- 12% and 77.0% +/- 2%, respectively.
Patients with cancer undergoing major abdominal surgery and using pneumatic compression for thromboembolic prophylaxis had a 14-fold greater odds of developing a pulmonary embolism compared with patients with benign disease. Randomized studies are needed to determine whether additional prophylactic measures may benefit this high-risk group of patients.
II-3.
评估妇科肿瘤手术术后肺栓塞的发生率及预后意义。
从我们的数据库中识别出2001年6月至2003年6月期间接受妇科肿瘤手术且仅采用间歇性气压压迫和早期活动进行静脉血栓栓塞预防的所有患者。根据手术类型（大型/小型腹部手术或非腹部手术）、诊断（恶性/非恶性）和癌症亚型对患者进行分组。通过卡方分析和逻辑回归对各组进行比较。采用Kaplan-Meier法和Mantel-Byar检验研究生存率。
在这2年期间共识别出1373例手术患者，包括839例大型腹部手术病例和534例小型腹部手术或非腹部手术病例。在839例患者中，507例诊断为癌症，332例为良性。接受大型腹部手术的癌症患者中肺栓塞的发生率为4.1%（21/507），而接受大型腹部手术且检查结果为良性的患者中肺栓塞的发生率为0.3%（1/332）（P <.001，比值比[OR] 13.8，95%置信区间[CI] 1.9 - 102.1）。接受小型/非腹部手术的患者中肺栓塞的发生率为0.4%（2/536）。癌症诊断和年龄超过60岁被确定为肺栓塞的危险因素（P =.009，OR 0.31，95% CI 0.13 - 0.74）。有肺栓塞和无肺栓塞患者的1年生存率分别为48.0%±12%和77.0%±2%。
与良性疾病患者相比，接受大型腹部手术并采用气压压迫预防血栓栓塞的癌症患者发生肺栓塞的几率高14倍。需要进行随机研究以确定额外的预防措施是否可能使这一高危患者群体受益。
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