Smith Brian R, Diniz Sidney, Stamos Michael, Nguyen Ninh T
Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, 333 City Blvd West, Ste 850, Orange, CA 92868, USA.
Arch Surg. 2011 Dec;146(12):1424-7. doi: 10.1001/archsurg.2011.204.
To characterize the location, incidence, and timing of deep venous thrombosis (DVT) after general surgical procedures.
Retrospective data review.
University hospital.
Of 2189 patients who underwent general surgical operation, 35 (1.6%) developed DVT afterward.
Main outcome measures included patient characteristics, location of DVT (lower vs upper), time of DVT diagnosis from the index operation (days), time of diagnosis according to discharge (inpatient vs outpatient), any associated pulmonary embolism, and mortality.
There were 22 men and 13 women with a mean age of 58 years. The index general surgical operations included pancreatic surgery (n = 10), esophagogastric surgery (n = 8), intestinal/colorectal surgery (n = 13), and other (n = 5). Diagnosis of DVT was based on symptoms in 94.3% of cases and based on routine duplex screening in 5.7% of cases. Upper extremity DVTs occurred in 40%; lower extremity DVTs occurred in 45.7%; and combined upper and lower extremity DVTs occurred in 14.3% of patients. The mean time between diagnosis of DVT and the index operation was 8.6 days with 29 of 35 patients (83%) with DVT diagnosed as an inpatient and 17% diagnosed in the outpatient setting. Catheter-associated DVT occurred in 21 of 35 patients (60%); 19 patients had an upper extremity catheter and 2 patients had a femoral catheter. Twenty-two of 35 patients (62.9%) with postoperative DVT had other concomitant complications such as ventilator dependency, sepsis, renal failure, surgical site infection, and pneumonia. Deep venous thrombosis with concomitant pulmonary embolism occurred in 4 of 35 patients (11.4%), with 1 of these 4 patients having only upper extremity DVT. The 30-day mortality in this study cohort was 14.2%.
In the presence of prophylaxis, the incidence of DVT after general surgical operation is low, with more than 80% of cases diagnosed in the inpatient setting. Since more than half of the DVTs are catheter induced, efforts for DVT prevention should include more attention to the need for a central catheter, limiting the amount of time of a central catheter, and possibly the use of anticoagulation in the presence of a central catheter.
描述普通外科手术后深静脉血栓形成（DVT）的部位、发生率及发生时间。
回顾性数据审查。
大学医院。
在2189例行普通外科手术的患者中，35例（1.6%）术后发生DVT。
主要观察指标包括患者特征、DVT部位（下肢与上肢）、从索引手术至DVT诊断的时间（天）、根据出院情况的诊断时间（住院患者与门诊患者）、是否伴有肺栓塞以及死亡率。
有22名男性和13名女性，平均年龄58岁。索引普通外科手术包括胰腺手术（n = 10）、食管胃手术（n = 8）、肠道/结直肠手术（n = 13）以及其他手术（n = 5）。94.3%的DVT病例根据症状诊断，5.7%的病例根据常规双功超声筛查诊断。40%的患者发生上肢DVT；45.7%的患者发生下肢DVT；14.3%的患者同时发生上肢和下肢DVT。DVT诊断与索引手术之间的平均时间为8.6天，35例患者中有29例（83%）在住院期间被诊断为DVT，17%在门诊被诊断。35例患者中有21例（60%）发生导管相关DVT；19例患者有上肢导管，2例患者有股静脉导管。35例术后DVT患者中有22例（62.9%）伴有其他并发症，如呼吸机依赖、脓毒症、肾衰竭、手术部位感染和肺炎。35例患者中有4例（11.4%）发生伴有肺栓塞 的DVT，这4例患者中有1例仅发生上肢DVT。本研究队列的30天死亡率为14.2%。
在采取预防措施的情况下，普通外科手术后DVT的发生率较低，超过80%的病例在住院期间被诊断。由于超过一半的DVT是由导管引起的，预防DVT的努力应包括更多关注中心静脉导管的必要性、限制中心静脉导管的使用时间，并可能在存在中心静脉导管时使用抗凝治疗。
