Qu Hong, Li Zhan, Zhai Zhenguo, Liu Chongdong, Wang Shuzhen, Guo Shuli, Zhang Zhenyu
From the Department of Obstetrics and Gynecology (HQ, ZL, CL, SW, SG, ZZ); and Department of respiration, Beijing Chao-yang Hospital affiliated to Capital Medical University, Beijing, China (ZZ).
Medicine (Baltimore). 2015 Sep;94(39):e1653. doi: 10.1097/MD.0000000000001653.
The purpose of this study was to determine the risk stratification of deep venous thrombosis (DVT) in patients undergoing gynecological surgery. A retrospective study was conducted with a cohort of 739 consecutive female patients undergoing gynecological surgery between May 2008 and July 2013 in Beijing Chao-yang hospital. DVT of the leg was detected using complete compression and color Doppler ultrasound. Pulmonary embolism (PE) was diagnosed by computed tomography pulmonary angiogram (CTPA). The overall incidence of DVT was 9.20% (68/739) in this patient population, including 16 (2.17%) symptomatic DVT and 52 (7.04%) silent DVT. A total of 66 (97.06%) DVT events were found within 7 days of surgery and 2 (2.94%) after 1 week. 94.82% thrombi were located in distal vein, and the rest 5.18% located in proximal and distal veins. Among the 68 patients with DVT, 46 patients with suspected PE received CTPA and 21 (45.65%) were confirmed with PE. Six independent factors including varicose vein, bed rest time ≥ 48 h, length of operation ≥ 3 h, laparotomy surgery, hypertension, and age ≥ 50 years significantly increased the incidence of postoperative DVT on multivariate analysis. Patients with none risk factor are at low risk, with 1 or 2 risk factors are at moderate risk, and with ≥ 3 factors are at high risk of DVT. The incidence of postoperative DVT and PE after gynecological surgery is high in patients with moderate or high-risk level. Noninvasive detection of DVT in 7 days after surgery is necessary because most patients showed no typical symptoms. Appropriate prophylaxis could be performed in patients at moderate or high risk of DVT.
本研究的目的是确定妇科手术患者深静脉血栓形成（DVT）的风险分层。对2008年5月至2013年7月在北京朝阳医院连续接受妇科手术的739例女性患者进行了一项回顾性研究。采用全下肢压迫彩色多普勒超声检测下肢DVT。通过计算机断层扫描肺动脉造影（CTPA）诊断肺栓塞（PE）。该患者人群中DVT的总体发生率为9.20%（68/739），其中有症状DVT 16例（2.17%），无症状DVT 52例（7.04%）。共66例（97.06%）DVT事件发生在术后7天内，2例（2.94%）发生在1周后。94.82%的血栓位于远端静脉，其余5.18%位于近端和远端静脉。在68例DVT患者中，46例疑似PE的患者接受了CTPA检查，其中21例（45.65%）确诊为PE。多因素分析显示，静脉曲张、卧床时间≥48小时、手术时间≥3小时、剖腹手术、高血压和年龄≥50岁这六个独立因素显著增加了术后DVT的发生率。无危险因素的患者为低风险，有1或2个危险因素的患者为中度风险，有≥3个危险因素的患者为DVT高风险。中高危水平的妇科手术患者术后DVT和PE的发生率较高。术后7天内对DVT进行无创检测很有必要，因为大多数患者没有典型症状。对于DVT中高危患者可进行适当的预防。
