Endoh Hideki, Shiratori Kazuaki, Horigome Miki, Uematsu Dai, Takehana Takuo, Sakamoto Taro, Fukushima Kazuyuki, Ishige Hiroyuki, Watanabe Hitoshi, Yazaki Yoshikazu
Department of Thoracic Surgery, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan.
Working Group of Venous Thrombosis Prevention, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan.
Ann Med Surg (Lond). 2022 Apr 14;77:103627. doi: 10.1016/j.amsu.2022.103627. eCollection 2022 May.
Pulmonary embolism (PE) from deep venous thrombosis (DVT) can be a fatal postoperative complication. Preventive measures for venous thromboembolism (VTE) was evaluated in this hospital.
Preoperative DVT screening following surgery under general anesthesia in 2009-2016 was examined, and then, 217 patients diagnosed with DVT by preoperative leg-ultrasound (US) between 2014 and 2016 were retrospectively analyzed.
There were 24,826 operations under general anesthesia in the study period. Preoperative leg-US was performed in 5345 (21.5%) patients, and 648 (12.1% of patients, 2.6% of total operations) were diagnosed with DVT. In 2014-2016, 217 patients, which is 11.7% of patients undergoing leg-US, were diagnosed with DVT. DVT was found in the proximal veins (upper popliteal vein) in 86 (39.6%) patients. A total of 143 (62%) patients were considered to have organized thrombi, no patient developed pulmonary embolism, and 133 (58%) patients were discharged without follow-up examination for DVT. Ninety-six patients were evaluated for changes on leg-US, with no difference in the results with and without anticoagulant use. On multivariate logistic regression analysis, anticoagulants appeared effective for non-organized thrombi, higher D-dimer levels (≥10 μg/mL), or orthopedic surgery.
Preoperative screening for DVT did not appear useful, and treatment of asymptomatic DVT was not always necessary.
深静脉血栓形成（DVT）导致的肺栓塞（PE）可能是一种致命的术后并发症。本医院对静脉血栓栓塞症（VTE）的预防措施进行了评估。
检查了2009 - 2016年全身麻醉手术后的术前DVT筛查情况，然后对2014年至2016年间经术前腿部超声（US）诊断为DVT的217例患者进行了回顾性分析。
研究期间共有24826例全身麻醉手术。5345例（21.5%）患者进行了术前腿部超声检查，其中648例（占患者的12.1%，占总手术量的2.6%）被诊断为DVT。在2014 - 2016年，217例患者（占接受腿部超声检查患者的11.7%）被诊断为DVT。86例（39.6%）患者的DVT出现在近端静脉（腘上静脉）。共有143例（62%）患者被认为有机化血栓形成，无患者发生肺栓塞，133例（58%）患者出院时未进行DVT的随访检查。对96例患者进行了腿部超声检查结果变化的评估，使用抗凝剂与否的结果无差异。多因素逻辑回归分析显示，抗凝剂对非机化血栓、较高的D - 二聚体水平（≥10μg/mL）或骨科手术似乎有效。
术前筛查DVT似乎并无用处，无症状DVT并非总是需要治疗。
