间歇性气动压迫联合低分子量肝素预防食管癌手术中静脉血栓栓塞事件

Intermittent pneumatic compression in combination with low-molecular weight heparin in the prevention of venous thromboembolic events in esophageal cancer surgery.

作者信息

Parry Kevin, Sadeghi Amir-Hossein, van der Horst Sylvia, Westerink Jan, Ruurda Jelle P, van Hillegersberg Richard

机构信息

Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

J Surg Oncol. 2017 Feb;115(2):181-185. doi: 10.1002/jso.24480. Epub 2017 Jan 5.

DOI:10.1002/jso.24480

PMID:28054341

Abstract

INTRODUCTION

Aim of this study was to evaluate the use of Intermittent Pneumatic Compression (IPC) in the prevention of symptomatic venous thromboembolic events (VTE) in patients undergoing esophagectomy for cancer.

METHODS

From a prospective database, all patients operated between 2010 and 2014 received IPC in addition to LMWH and were compared to a historical cohort of patients treated LMWH only (2004-2009).

RESULTS

Of the 313 included patients, 195 (62%) received IPC. Patients with IPC received neoadjuvant chemoradiation more often (45% vs. 3%, P < 0.001), whereas, neoadjuvant chemotherapy was equally distributed (31% vs. 34%, P = 0.631). There were no differences with regard to surgical approach, operative time, blood loss, and ICU stay. Patients treated without IPC had a longer hospital stay (18 vs. 15 days, P = 0.014). Overall, 12 clinical VTE's occurred in 11 patients, which consisted of two deep venous thromboses and 10 pulmonary embolisms. In the group of patients, who received IPC 1.5% developed a symptomatic VTE compared to 6.8% in patients without IPC (OR = 0.215; 95% CI = 0.06-0.83). Multivariate analysis identified IPC as the only independent prognostic factor correlated with a reduction in postoperative VTE's (OR = 0.225; 95% CI = 0.06-0.88).

CONCLUSION

摘要

引言

本研究的目的是评估间歇性气动压迫（IPC）在预防接受食管癌切除术患者发生有症状静脉血栓栓塞事件（VTE）中的应用。

方法

从一个前瞻性数据库中，选取2010年至2014年间接受手术的所有患者，这些患者除接受低分子肝素（LMWH）外还接受了IPC，并与仅接受LMWH治疗的历史队列患者（2004 - 2009年）进行比较。

结果

在纳入的313例患者中，195例（62%）接受了IPC。接受IPC的患者更常接受新辅助放化疗（45%对3%，P < 0.001），而新辅助化疗的分布相同（31%对34%，P = 0.631）。在手术方式、手术时间、失血量和重症监护病房停留时间方面没有差异。未接受IPC治疗的患者住院时间更长（18天对15天，P = 0.014）。总体而言，11例患者发生了12次临床VTE，包括2次深静脉血栓形成和10次肺栓塞。在接受IPC的患者组中，1.5%发生了有症状的VTE，而未接受IPC的患者中这一比例为6.8%（比值比[OR] = 0.215；95%置信区间[CI] = 0.06 - 0.83）。多因素分析确定IPC是与术后VTE减少相关的唯一独立预后因素（OR = 0.225；95% CI = 0.06 - 0.88）。