Rottenstreich Amihai, Kalish Yosef, Kleinstern Geffen, Yaacov Almog Ben, Dux Joseph, Nissan Aviram
Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel.
J Surg Oncol. 2017 Dec;116(7):914-920. doi: 10.1002/jso.24746. Epub 2017 Jun 26.
We investigated the risk factors, incidence, and role of thromboprophylaxis in the development of thrombosis following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
We reviewed data of patients with CRS/HIPEC in three hospitals.
Overall, 192 patients underwent CRS/HIPEC during 2007-2016. Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 h before surgery until discharge) was provided for all patients; and 116 (60.4%) also received an extended course of enoxaparin for 2-4 weeks after discharge. Twenty-six patients experienced thrombotic complications (13.5%) including portal-splenic-mesenteric venous thrombosis (n = 11, 5.7%), pulmonary embolism (n = 10, 5.2%), and deep vein thrombosis (n = 5, 2.6%); most (n = 21, 80.8%) occurred after hospital discharge. Univariate analysis identified Peritoneal Cancer Index, intraoperative transfusion requirement, operative blood loss, operative time, lengths of hospital, and intensive care unit stay, and lack of administration of anticoagulation at discharge as significantly associated with thrombosis. With multivariate analysis, only the lack of anticoagulation therapy at discharge remained significantly associated with thrombosis (P = 0.0001).
Thromboembolic complications are common following CRS/HIPEC. As significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation, we support its use for at least 2 weeks after discharge.
我们研究了减瘤手术联合热灌注化疗（CRS/HIPEC）后血栓形成的危险因素、发生率及血栓预防的作用。
我们回顾了三家医院接受CRS/HIPEC治疗的患者数据。
总体而言，2007年至2016年间有192例患者接受了CRS/HIPEC治疗。所有患者均接受了机械性（大腿长度的气动压迫袜）和药物性血栓预防（术前12小时开始每日皮下注射40mg依诺肝素，直至出院）；116例（60.4%）患者出院后还接受了2至4周的依诺肝素延长疗程治疗。26例患者出现血栓并发症（13.5%），包括门静脉-脾静脉-肠系膜静脉血栓形成（n = 11，5.7%）、肺栓塞（n = 10，5.2%）和深静脉血栓形成（n = 5，2.6%）；大多数（n = 21，80.8%）发生在出院后。单因素分析确定腹膜癌指数、术中输血需求、手术失血、手术时间、住院时间和重症监护病房停留时间以及出院时未使用抗凝药物与血栓形成显著相关。多因素分析显示，只有出院时未进行抗凝治疗与血栓形成仍显著相关（P = 0.0001）。
CRS/HIPEC术后血栓栓塞并发症很常见。由于接受延长抗凝疗程的患者血栓形成率显著降低，我们支持出院后至少使用2周抗凝治疗。
