定义肝切除术后静脉血栓栓塞症的发生率和危险因素。
Defining incidence and risk factors of venous thromboemolism after hepatectomy.
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
J Gastrointest Surg. 2014 Jun;18(6):1116-24. doi: 10.1007/s11605-013-2432-x. Epub 2013 Dec 13.
BACKGROUND
The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is poorly defined, leading to varied use of VTE prophylaxis among surgeons. We sought to define the incidence of VTE after liver surgery and identify risk factors associated with VTE.
METHODS
Incidence of VTE and associated risk factors within 90 days of hepatic resection between 2006 and 2012 at a major academic center was analyzed. Risk factors for VTE were identified using univariate and multivariate analyses.
RESULTS
A total of 599 patients were included in the study cohort; 30 (5.0 %) had a prior history of VTE. The indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; n = 402, 67.1 %) while 195 (32.6 %) patients underwent a major hepatectomy (≥3 Couinaud segments). Three hundred seven (51.3 %) patients were started on VTE chemoprophylaxis preoperatively with 407 (67.8 %) patients receiving VTE chemoprophylaxis within 24 h of surgery. Twenty-eight (4.7 %) patients developed VTE; 20 (3.3 %) had deep venous thrombosis (DVT), 11 (1.8 %) had pulmonary embolism (PE), and three (0.5 %) developed both DVT and PE. Among the VTE patients, 23 (82.1 %) had received VTE chemoprophylaxis. On multivariate analyses, history of VTE (odds ratio [OR] 4.51, 95 % confidence interval [CI] 1.81-17.22, P = 0.03), prolonged operative time (OR 1.17 per additional hour, 95 % CI 1.04-1.32, P = 0.009), and increased length of stay (LOS) (OR 1.07, 95 % CI 1.02-1.12, P = 0.01) were independent risk factors for VTE.
CONCLUSION
VTE within 90 days of hepatic resection is common, occurring in nearly one in 20 patients. Most VTE events occurred among patients who received current best practice prophylaxis for VTE. More aggressive strategies to identify and reduce the risk of VTE in patients at highest risk of VTE, including those with a history of VTE, extended operative time, and prolonged LOS, are warranted.
背景
行肝切除术的患者中静脉血栓栓塞症（VTE）的发生率定义不佳，导致外科医生对 VTE 预防的使用存在差异。我们旨在明确肝手术后 VTE 的发生率，并确定与 VTE 相关的危险因素。
方法
分析了 2006 年至 2012 年期间在一个主要学术中心行肝切除术 90 天内 VTE 的发生率和相关危险因素。使用单因素和多因素分析确定 VTE 的危险因素。
结果
共纳入 599 例研究队列患者；30 例（5.0%）有 VTE 既往史。手术适应证为恶性（90.8%）和良性病变（9.2%）。大多数患者接受了小范围肝切除术（<3 个 Couinaud 段；n=402，67.1%），195 例（32.6%）患者接受了大范围肝切除术（≥3 个 Couinaud 段）。307 例（51.3%）患者术前开始使用 VTE 化学预防，407 例（67.8%）患者在手术 24 小时内接受 VTE 化学预防。28 例（4.7%）患者发生 VTE；20 例（3.3%）患者发生深静脉血栓形成（DVT），11 例（1.8%）患者发生肺栓塞（PE），3 例（0.5%）患者发生 DVT 和 PE。在 VTE 患者中，23 例（82.1%）接受了 VTE 化学预防。多因素分析显示，VTE 病史（比值比 [OR] 4.51，95%置信区间 [CI] 1.81-17.22，P=0.03）、手术时间延长（每增加 1 小时，OR 1.17，95%CI 1.04-1.32，P=0.009）和住院时间延长（OR 1.07，95%CI 1.02-1.12，P=0.01）是 VTE 的独立危险因素。
结论
肝切除术后 90 天内 VTE 很常见，近五分之一的患者发生 VTE。大多数 VTE 事件发生在接受目前最佳 VTE 预防措施的患者中。对于 VTE 风险最高的患者，包括有 VTE 病史、手术时间延长和住院时间延长的患者，需要采取更积极的策略来识别和降低 VTE 的风险。
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