From the Departments of Gynecologic Oncology and Biostatistics, The University of Texas MD Anderson Medical Cancer Center, Houston, Texas; and Hospital de Clinicas de Porto Alegre, Gynecologic Oncology Service, Universidade Federal Do Rio Grande do Sul, Porto Alegre, Brazil.
Obstet Gynecol. 2010 Oct;116(4):956-961. doi: 10.1097/AOG.0b013e3181f240f7.
To estimate the incidence of venous thromboembolism among patients undergoing gynecologic laparoscopy and characterize the risk of venous thromboembolism among patients with gynecologic malignancy.
Data were collected for patients who underwent laparoscopic gynecologic surgery from January 2000 to January 2009. Incidence of deep vein thrombosis (DVT) or pulmonary embolism diagnosed within 6 weeks of surgery was estimated. Fisher's exact test was used to estimate the association between the presence of perioperative venous thromboembolism and categorical variables.
Six (of 849) patients developed symptomatic venous thromboembolism (0.7%, 95% confidence interval: 0.024-1.44%). The median time to diagnosis of venous thromboembolism was postoperative day 15.5 (range, 1-41 days), median body mass index was 25.4 kg/m (range, 18.4-50 kg/m), median operative time was 176 minutes (range, 53-358 minutes), and median estimated blood loss was 125 mL (range, 10-250 mL). Five of 430 (1.2%) patients with a history of gynecologic malignancy developed postoperative thromboembolic events. Venous thromboembolism was diagnosed in three of 662 (0.5%) patients undergoing intermediate complexity procedures and three of 106 (2.8%) patients undergoing high-complexity procedures. Three patients with venous thromboembolism (50%) had a history of at least one previous modality of cancer treatment before laparoscopy. One patient (17%) had DVT only, four (67%) had pulmonary emboli without an identified DVT, and one (17%) had both. There were no associated mortalities.
The incidence of thromboembolism in patients undergoing low- and intermediate-complexity, minimally invasive surgery was low, even among patients with a gynecologic malignancy. Patients undergoing high-complexity, minimally invasive procedures may benefit from postoperative anticoagulation.
II.
评估妇科腹腔镜手术患者静脉血栓栓塞的发生率，并确定妇科恶性肿瘤患者静脉血栓栓塞的风险特征。
本研究收集了 2000 年 1 月至 2009 年 1 月期间接受腹腔镜妇科手术的患者的数据。估计术后 6 周内诊断为深静脉血栓形成（DVT）或肺栓塞的发生率。采用 Fisher 确切检验估计围手术期静脉血栓栓塞与分类变量之间的关联。
6 例（849 例患者中的 6 例，0.7%，95%置信区间：0.024-1.44%）患者出现有症状静脉血栓栓塞。诊断静脉血栓栓塞的中位时间为术后第 15.5 天（范围，1-41 天），中位体重指数为 25.4kg/m²（范围，18.4-50kg/m²），中位手术时间为 176 分钟（范围，53-358 分钟），中位估计出血量为 125mL（范围，10-250mL）。430 例妇科恶性肿瘤病史患者中有 5 例（1.2%）发生术后血栓栓塞事件。662 例中等复杂程度手术患者中有 3 例（0.5%）和 106 例高复杂程度手术患者中有 3 例（2.8%）诊断为静脉血栓栓塞。3 例（50%）静脉血栓栓塞患者在腹腔镜检查前至少有一次既往癌症治疗史。1 例（17%）患者仅患有 DVT，4 例（67%）患者患有未发现 DVT 的肺栓塞，1 例（17%）患者患有两者。无相关死亡。
低复杂程度和中等复杂程度、微创手术患者的血栓栓塞发生率较低，即使是妇科恶性肿瘤患者也是如此。高复杂程度微创手术患者可能受益于术后抗凝治疗。
II 级。
