Moon Mi Hyoung, Beck Kyongmin Sarah, Moon Young Kyu, Park Jae Kil, Sung Sook Whan
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2017 Sep 27;12(9):e0185140. doi: 10.1371/journal.pone.0185140. eCollection 2017.
We aimed to evaluate the incidence and clinical features of vascular stump thrombus after oncologic lung surgery.
A retrospective analysis of records from our institutional database dated between 2009 and 2016 was performed. Data regarding demographics, clinical presentation, medication use, operative findings, pathology, and radiologic findings were retrieved.
The study cohort consisted of 648 oncologic surgeries for primary lung cancer. The incidence of thrombus in the entire population was 5.7% (37/648). Most thrombi were incidentally found on follow-up chest computed tomography scans. Univariate Cox proportional hazard analysis showed that age (p = 0.02), adjuvant therapy (p <0.001), neoadjuvant therapy (p = 0.04), left-sided surgery (p = 0.02), complex surgery greater than simple lobectomy or segmentectomy (p <0.001), advanced stages (p <0.001), non-adenocarcinoma (p = 0.003), and thoracotomy approach (p = 0.009) were associated with an increased risk of vascular stump thrombus. There were no embolic events in our cohort, except for a case of pulmonary thromboembolism. During follow-up, 43.2% (16/37) of thrombi had completely resolved, 48.6% (18/37) showed partial regression and stabilization, and 8.1% (3/37) had progressed.
The incidence of vascular stump thrombus in our study was not negligible. The clinical course of stump thrombus appears to be benign in most cases. Anticoagulation may be used with caution based on an individual basis depending on each patient's risk factors.
我们旨在评估肿瘤性肺切除术后血管残端血栓的发生率及临床特征。
对我院机构数据库中2009年至2016年的记录进行回顾性分析。检索了有关人口统计学、临床表现、用药情况、手术发现、病理学及影像学检查结果的数据。
研究队列包括648例原发性肺癌肿瘤手术。总体血栓发生率为5.7%（37/648）。大多数血栓是在随访胸部计算机断层扫描时偶然发现的。单因素Cox比例风险分析显示，年龄（p = 0.02）、辅助治疗（p <0.001）、新辅助治疗（p = 0.04）、左侧手术（p = 0.02）、大于单纯肺叶切除术或肺段切除术的复杂手术（p <0.001）、晚期（p <0.001）、非腺癌（p = 0.003）及开胸手术方式（p = 0.009）与血管残端血栓风险增加相关。除1例肺血栓栓塞病例外，我们的队列中未发生栓塞事件。随访期间，43.2%（16/37）的血栓完全溶解，48.6%（18/37）部分缩小并稳定，8.1%（3/37）进展。
我们研究中血管残端血栓的发生率不可忽视。大多数情况下，残端血栓的临床病程似乎是良性的。可根据每个患者的危险因素，在个体基础上谨慎使用抗凝治疗。
