Department of Surgical Oncology, The University of Tokyo, Japan.
Department of Surgical Oncology, The University of Tokyo, Japan.
Asian J Surg. 2019 Sep;42(9):863-873. doi: 10.1016/j.asjsur.2018.12.013. Epub 2019 Jan 23.
Colorectal surgery is associated with a high risk of perioperative venous thromboembolism (VTE), and this risk is especially high following colorectal cancer resection and surgery for inflammatory bowel disease. Previous analyses of large databases have reported the incidence of postoperative VTE in this population to be approximately 1.1%-2.5%. Therefore, to minimize this risk, patients should be offered appropriate prophylaxis, which may involve a combination of mechanical and pharmacologic prophylaxis with low-dose unfractionated heparin or low molecular weight heparin as recommended by several guidelines. Prior to initiation of treatment, appropriate risk stratification should be performed according to the patients' basic and disease-related as well as procedure-related risk factors, and post-operative factors. Furthermore, a risk-benefit calculation that takes into account patients' VTE and bleeding risk should be performed prior to starting pharmacologic prophylaxis and to help determine the duration of treatment.
结直肠手术与围手术期静脉血栓栓塞症（VTE）的风险相关较高，尤其是在结直肠癌切除术后和炎症性肠病手术后。先前对大型数据库的分析报告称，该人群术后 VTE 的发生率约为 1.1%-2.5%。因此，为了最大限度地降低这种风险，应向患者提供适当的预防措施，包括根据几个指南推荐使用低剂量未分级肝素或低分子量肝素的机械和药物预防措施的组合。在开始治疗之前，应根据患者的基本和疾病相关以及手术相关的危险因素以及术后因素进行适当的风险分层。此外，在开始药物预防之前，应进行风险-效益计算，以考虑患者的 VTE 和出血风险，以帮助确定治疗的持续时间。
