Dong H H, Cai Y S, Liang X N, Miao J B, Chen Q S, Gao Y D, Li H
Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2021 Nov 9;101(41):3417-3421. doi: 10.3760/cma.j.cn112137-20210418-00929.
To analyze the incidence and risk factors for postoperative venous thromboembolism(VTE) in patients with stage Ⅰa non-small-cell lung cancer(NSCLC), so as to find evidence for further research of prophylactic anticoagulation. A total of 132 patients with stage Ⅰa NSCLC, 42 males and 90 females aged from 26 to 79 years with an average of (57±10) years, were retrospectively included in this study. All of them underwent surgical treatment at the Department of Thoracic Surgery of Beijing Chaoyang Hospital Affiliated with Capital Medical University from January 2017 to October 2020. A lower extremity venous ultrasound was performed before and after the operation. Participants were divided into VTE group (=11) or non-VTE group (=121) according to whether or not VTE occurred after operation. The surgical conditions, test indicators, imaging information, pathology information were compared between the two groups. Logistic regression analysis was performed to test the associations of VET with putative risks factors in which significant differences were observed. The independent risk factors of VET were determined by this way. Postoperative VTE occurred in 11 cases (8.3%), including 10 cases (90.9%) of deep vein thrombosis (DVT) of lower limbs and 1 case (9.1%) of DVT complicated with pulmonary embolism (PE). The mean age of Patients in the VTE group was older than that in non-VTE Group ((65±9) years vs (57±10) years, =0.009). On the fifth day after operation, patients in both groups had significantly higher D-dimer level compared with that before operation (3.18(1.55, 5.15) vs 1.54(1.09, 2.57); 2.66(1.17, 4.65) vs 1.34(0.78, 2.04))(both <0.05). The value of neuron-specific enolase (NSE) and the number of lymph nodes removed during the operation in the VTE group were significantly higher than those in the non-VTE group ((21.54±12.37) vs (14.72±5.75); (19.7±8.2) vs (13.0±7.9)) (both <0.05). There was no statistically significant difference in the approach of surgery, imaging features (tumor location, vascular cluster signs, etc.), and pathological information (pathological types, etc.) (all >0.05). The logistic regression analysis showed that the number of lymph nodes removed during the operation was an independent risk factor related to the occurrence of VTE (=1.306, 95%1.000-1.600,<0.05). The incidence of postoperative VTE in patients with stage Ⅰa NSCLC is approximately 8.3%. The number of lymph nodes removed during the operation may be an independent risk factor for postoperative VTE in patients with stage Ⅰa NSCLC.
分析Ⅰa期非小细胞肺癌（NSCLC）患者术后静脉血栓栓塞症（VTE）的发生率及危险因素，为进一步研究预防性抗凝治疗寻找依据。本研究回顾性纳入了132例Ⅰa期NSCLC患者，其中男性42例，女性90例，年龄26～79岁，平均（57±10）岁。2017年1月至2020年10月期间，所有患者均在首都医科大学附属北京朝阳医院胸外科接受手术治疗。术前和术后均行下肢静脉超声检查。根据术后是否发生VTE将参与者分为VTE组（n = 11）和非VTE组（n = 121）。比较两组的手术情况、检测指标、影像信息、病理信息。进行Logistic回归分析，以检验VTE与观察到显著差异的假定危险因素之间的关联。通过这种方式确定VTE的独立危险因素。术后发生VTE 11例（8.3%），其中下肢深静脉血栓形成（DVT）10例（90.9%），DVT合并肺栓塞（PE）1例（9.1%）。VTE组患者的平均年龄高于非VTE组（（65±9）岁 vs （57±10）岁，P = 0.009）。术后第5天，两组患者的D-二聚体水平均显著高于术前（3.18（1.55，5.15） vs 1.54（1.09，2.57）；2.66（1.17，4.65） vs 1.34（0.78，2.04））（均P < 0.05）。VTE组神经元特异性烯醇化酶（NSE）值及术中清扫淋巴结数目均显著高于非VTE组（（21.54±12.37） vs （14.72±5.75）；（19.7±8.2） vs （13.0±7.9））（均P < 0.05）。手术方式、影像特征（肿瘤位置、血管集束征等）及病理信息（病理类型等）差异均无统计学意义（均P > 0.05）。Logistic回归分析显示，术中清扫淋巴结数目是与VTE发生相关的独立危险因素（P = 1.306，95%CI 1.000～1.6
