Gastric Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan.
Gastric Cancer. 2010 Jun;13(2):117-22. doi: 10.1007/s10120-010-0551-6. Epub 2010 Jul 3.
There is a lack of published data on the incidence of pulmonary thromboembolism (PTE) after resections for gastric cancer. We report the incidence of PTE after gastric cancer surgery with routine thromboprophylaxis from a high-volume center.
Between October 2002 and December 2008, 3262 patients underwent gastric cancer surgery with routine thromboprophylaxis using low-dose unfractionated heparin, intermittent pneumatic compression, fluid infusion, and graduated compression stockings. Patients diagnosed with PTE were identified from a prospectively collected database that included complications related to thromboprophylaxis.
Seven patients (0.2%) developed symptomatic PTE in this series. Multivariate analysis demonstrated that female sex (P = 0.029) and high body mass index (P = 0.025) were significant risk factors for PTE. The most common symptom was dyspnea (57%). Five patients (71%) developed PTE by the second postoperative day. All patients were treated successfully with medical treatment and no hospital deaths were recorded. Adverse events related to thromboprophylaxis included major postoperative bleeding in 10 (0.3%) of the 3262 patients. There were no cases of hematoma related to the insertion of epidural catheters for analgesia.
The routine use of thromboprophylaxis in Japanese patients undergoing gastric resection is safe and effective in reducing the incidence of pulmonary thromboembolism.
胃癌手术后肺血栓栓塞症（PTE）的发病率缺乏发表数据。我们报告了高容量中心常规血栓预防治疗后胃癌手术后 PTE 的发病率。
2002 年 10 月至 2008 年 12 月，3262 例胃癌患者接受常规低剂量未分级肝素、间歇性气动压缩、补液和分级压缩袜血栓预防治疗。从包括与血栓预防相关的并发症的前瞻性收集数据库中确定诊断为 PTE 的患者。
该系列中，7 例（0.2%）患者出现有症状的 PTE。多变量分析表明，女性（P=0.029）和高体重指数（P=0.025）是 PTE 的显著危险因素。最常见的症状是呼吸困难（57%）。5 例（71%）患者在术后第二天发生 PTE。所有患者均成功接受药物治疗，无医院死亡记录。与血栓预防相关的不良事件包括 3262 例患者中有 10 例（0.3%）发生重大术后出血。没有因插入硬膜外导管进行镇痛而导致血肿的病例。
在日本接受胃癌切除术的患者中常规使用血栓预防是安全有效的，可降低肺血栓栓塞症的发病率。
