Sagalovich Daniel, Say Rollin, Kaouk Jihad, Mehrazin Reza
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
Urol Oncol. 2018 Mar;36(3):83-87. doi: 10.1016/j.urolonc.2017.12.010. Epub 2018 Jan 12.
With the emergence of evidence that venous thromboembolisms (VTE) typically occurs following discharge after urologic pelvic surgery, the focus on extended VTE prophylaxis has intensified. Urologists should have a comprehensive understanding of various VTE risk factors in order to weigh the risk of postoperative hemorrhage with the possibility of fatal pulmonary embolus. Risk factors such as advanced age, obesity, and active malignancy are especially common in patient's undergoing urologic pelvic surgery, and thus this issue becomes particularly relevant to the practicing urologist. In previous years, guidelines on extended VTE prophylaxis have either been vague or not urology specific; however, the European Association of Urology has recently issued recommendations on VTE prophylaxis stratified by VTE risk and surgery type. Although these guidelines are a major advance, definitive answers on this question may prove elusive in the form of prospective randomized data given the low incidence of clinically significant postoperative VTE.
随着有证据表明静脉血栓栓塞症（VTE）通常发生在泌尿外科盆腔手术后出院时，对延长VTE预防措施的关注日益增强。泌尿外科医生应全面了解各种VTE风险因素，以便权衡术后出血风险与致命性肺栓塞的可能性。高龄、肥胖和活动性恶性肿瘤等风险因素在接受泌尿外科盆腔手术的患者中尤为常见，因此这个问题对执业泌尿外科医生来说尤为重要。在过去几年中，关于延长VTE预防的指南要么含糊不清，要么并非泌尿外科特有的；然而，欧洲泌尿外科协会最近发布了按VTE风险和手术类型分层的VTE预防建议。尽管这些指南是一项重大进展，但鉴于临床上显著的术后VTE发生率较低，以前瞻性随机数据的形式给出这个问题的明确答案可能仍然难以实现。
