Department of Urology, University of Connecticut Medical Center, Farmington, CT 06030, USA.
J Endourol. 2013 Jun;27(6):800-3. doi: 10.1089/end.2012.0532. Epub 2013 Mar 6.
Venous thromboembolism (VTE) is a major complication of urologic surgery. Data are limited regarding the benefits of heparin prophylaxis for patients undergoing minimally invasive urologic surgery. The American Urological Association recommends sequential compression devices (SCDs) for urologic laparoscopic and robot-assisted procedures but provides no clear recommendations for the use of pharmacologic prophylaxis. We compare the rates of postoperative VTE in two groups of patients undergoing robot-assisted prostatectomy (RP) by two surgeons-one who consistently used heparin with SCDs (group 1) and the other who used SCDs alone (group 2) for prophylaxis.
An Institutional Review Board approved, prospectively managed database was analyzed. Group 1 received SCDs just before induction and 5000 units of heparin subcutaneously just after induction. SCDs were continued postoperatively, and heparin was administered twice a day until discharge. VTE rate, patient age, body mass index (BMI), operative time, lymphocele rate, length of stay (LOS), estimated blood loss (EBL), Gleason score, and pathologic stage were compared. Categorical variables were analyzed with the chi square test of proportions and continuous variables with t test using SPSS v 14 software.
There were 1486 consecutive patients who underwent RP between August 2007 and December 30, 2011. Of these, 922 patients received heparin/SCDs and 564 received SCDs alone. Age, BMI, EBL, medial LOS, Gleason score, and pathologic stage were the same in the two groups. There was a higher rate of positive nodes in group 2 (1.3% vs 3.5%). There was one lymphocele in each group. Although operative times were longer in group 2 (229 vs 170 min, P<0.001), the incidence of VTE was not statistically different (1.0% vs 0.7%, P=0.78). BMI, operative time, EBL, and the performance of lymph node dissection were not associated with VTE.
The risk of VTE in patients undergoing RP is low and not significantly reduced with the administration of prophylactic heparin/SCDs compared with SCDs alone.
静脉血栓栓塞症（VTE）是泌尿科手术的主要并发症。有关接受微创泌尿科手术的患者使用肝素预防的益处的数据有限。美国泌尿科协会建议对泌尿科腹腔镜和机器人辅助手术使用序贯压迫装置（SCD），但对使用药物预防未提供明确建议。我们比较了两位外科医生进行机器人辅助前列腺切除术（RP）的两组患者的术后 VTE 发生率，一位外科医生始终使用肝素联合 SCD（组 1）进行预防，另一位仅使用 SCD（组 2）进行预防。
分析了经机构审查委员会批准的前瞻性管理数据库。组 1 在诱导前使用 SCD，诱导后立即皮下注射 5000 单位肝素。术后继续使用 SCD，并每天给予两次肝素直至出院。比较 VTE 发生率、患者年龄、体重指数（BMI）、手术时间、淋巴囊肿发生率、住院时间（LOS）、估计失血量（EBL）、Gleason 评分和病理分期。使用 SPSS v 14 软件的卡方检验和 t 检验分析分类变量和连续变量。
2007 年 8 月至 2011 年 12 月 30 日期间，有 1486 例连续患者接受 RP。其中，922 例患者接受肝素/SCD，564 例患者仅接受 SCD。两组患者的年龄、BMI、EBL、中 LOS、Gleason 评分和病理分期相同。组 2 的阳性淋巴结比例更高（1.3%比 3.5%）。两组均有 1 例淋巴囊肿。尽管组 2 的手术时间较长（229 分钟比 170 分钟，P<0.001），但 VTE 的发生率并无统计学差异（1.0%比 0.7%，P=0.78）。BMI、手术时间、EBL 和淋巴结清扫的执行与 VTE 无关。
RP 患者发生 VTE 的风险较低，与单独使用 SCD 相比，预防性使用肝素/SCD 并不能显著降低 VTE 的风险。
