Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan.
Shirakawa Kosei General Hospital, 2-1 Toyochikamiyajirou, Shirakawa City, 961-0005, Japan.
BMC Surg. 2022 Mar 9;22(1):91. doi: 10.1186/s12893-022-01544-9.
Upper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space's width as a predictive factor for UEDVT in patients receiving esophagectomy.
This study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space's width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space.
Among all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space's width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively.
The existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.
上肢深静脉血栓形成（UEDVT）相对较少，但不容忽视，因为它可导致致命并发症。尽管有报道称，由于中央静脉导管（CVC）、癌症和手术侵袭，UEDVT 的发生率有所增加，但对于食管癌切除术来说，相关信息仍然有限。本研究旨在评估临床因素，包括 CVC 放置和血栓预防方法，以及胸骨后空间的宽度作为接受食管癌切除术患者发生 UEDVT 的预测因素。
本研究纳入了 66 例行胸骨后胃管重建的食管癌切除术患者。所有患者术后第 4 天常规行增强 CT 检查。术后第 2 天常规给予低分子肝素（LMWH）。为评估胸骨后空间的宽度，（a）术前 CT 测量胸骨至头臂动脉的距离，（b）胸骨至椎体的距离，并定义（a）与（b）的比值为胸骨后空间的宽度。
所有患者中，有 11 例（16.7%）发生 UEDVT，无一例术前接受 CVC 放置，而非 UEDVT 患者中有 7 例接受 CVC 放置。UEDVT 患者胸骨后空间的宽度明显小于非 UEDVT 患者（0.17 比 0.26；P < 0.0001）。宽度的截断值为 0.21，对 UEDVT 的预测具有较高的敏感性（87%）和特异性（82%）。
CVC 的存在可能不会影响 UEDVT 的发生，但术前评估胸骨后比值可能预测 UEDVT 的发生。
