Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
JAMA Otolaryngol Head Neck Surg. 2013 Nov;139(11):1143-50. doi: 10.1001/jamaoto.2013.4911.
Venous thromboembolism (VTE) is associated with significant morbidity and mortality in surgery patients, but little data exist on the incidence of VTE in head and neck cancer surgical patients.
To determine the incidence of VTE in postoperative patients with head and neck cancer.
DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery.
Total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging.
Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13%. Eight participants were identified with clinically significant VTE: 7 DVT and 1 PE. An additional 5 participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1%) was higher than that in patients without anticoagulation therapy (5.6%) (P = .01).
Hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE. Bleeding complications are elevated in patients receiving postoperative anticoagulation.
静脉血栓栓塞症（VTE）与手术患者的高发病率和死亡率相关，但有关头颈部癌症手术患者 VTE 发生率的数据很少。
确定头颈部癌症手术后患者 VTE 的发生率。
设计、地点和参与者：一项前瞻性研究，纳入了在一家三级保健学术外科中心住院的 100 例连续头颈部癌症手术患者。未常规使用化学预防。术后第 2 或第 3 天，患者接受临床检查和双功能超声检查（US）。对临床检查和 US 结果阴性的患者进行临床随访；对有深静脉血栓形成（DVT）或肺栓塞（PE）证据的患者给予抗凝治疗。有浅静脉血栓形成的患者在术后第 4、5 或 6 天行重复 US。患者在手术后 30 天内接受监测。
术后 30 天内通过诊断影像学确认的新发（包括浅部和深部）VTE 总例数。
在纳入的 111 例患者中，有 11 例在完成研究前退出，因此有 100 例患者纳入研究。VTE 的总发生率为 13%。8 例患者被诊断为有临床意义的 VTE：7 例 DVT 和 1 例 PE。另有 5 例患者通过 US 单独发现无症状的下肢浅静脉血栓形成。14%的患者接受了某种形式的术后抗凝治疗；这些患者的出血并发症发生率（30.1%）高于未接受抗凝治疗的患者（5.6%）（P =.01）。
未常规接受术后抗凝治疗的头颈部癌症住院患者发生 VTE 的风险增加。接受术后抗凝治疗的患者出血并发症发生率升高。
