胃癌患者胃切除术后静脉血栓栓塞的术前和术后临床特征：一项回顾性队列研究。
Preoperative and postoperative clinical signatures of postgastrectomy venous thromboembolism in patients with gastric cancer: A retrospective cohort study.
作者信息
Li Xiu-Ping, Wang Yun-Ying, Sun Yu-Shu, Zhang Li-Jiao, Zhao Xia-Ying, Liu Zhu-Qin, Jiang Hui-Min, Zha Jing-Dan, Zhang Xiao-Jie, Yan Jia-Ning, Pan Hong-Ying
机构信息
Department of General Surgery, Sir Run Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, 310016, China; Nursing Department, Sir Run Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou 310016, China.
Department of General Surgery, Sir Run Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, 310016, China; Zhejiang Provincial Key Laboratory of Laparoscopic Technology, Sir Run Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, 310016, China; Zhejiang University Innovation Center of Minimally Invasive Technology and Medical Equipment, Hangzhou, 310016, China.
出版信息
Asian J Surg. 2023 Apr;46(4):1556-1563. doi: 10.1016/j.asjsur.2022.08.083. Epub 2022 Sep 9.
BACKGROUND
This study aimed to identify preoperative and postoperative risk factors of venous thromboembolism (VTE) after gastrectomy in gastric cancer (GC) patients.
METHODS
757 GC patients underwent gastrectomy at our institution and 246 patients with elevated postoperative D-dimer levels who received Doppler ultrasonography of lower/upper extremity veins were enrolled. Clinicopathological factors data were collected, and the differences in clinicopathological factors between postoperative VTE (+) and VTE (-) groups were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors of postgastrectomy VTE.
RESULTS
Of 246 patients with elevated postgastrectomy D-dimer concentrations, 74 patients showed thrombosis in lower/upper extremity veins. Among preoperative factors, age, WBC level, D-dimer concentration, and blood glucose level were significantly higher in the postoperative VTE (+) group. Among the postoperative factors, hemoglobin level was significantly lower in the postoperative VTE (+) group. Among the pathological factors, tumor stage, depth of invasion and TNM classification indicated higher malignancy in the postoperative VTE (+) group. Univariate logistic regression analysis indicated age, preoperative blood glucose level, postoperative hemoglobin level, tumor stage, depth of invasion, and TNM classification as the independent risk factors for postgastrectomy VTE, whereas multivariate logistic regression analysis revealed age and tumor stage as independent risk factors for postgastrectomy VTE.
CONCLUSION
Our study revealed that age, preoperative blood glucose level, postoperative anemia, and tumor malignancy were independent risk factors for GC patients exhibiting postgastrectomy VTE. Therefore, the perioperative monitoring, assessment and management of risk factors are important in achieving better outcomes after gastrectomy.
背景
本研究旨在确定胃癌（GC）患者胃切除术后静脉血栓栓塞（VTE）的术前和术后危险因素。
方法
757例GC患者在我院接受了胃切除术，纳入246例术后D-二聚体水平升高且接受下肢/上肢静脉多普勒超声检查的患者。收集临床病理因素数据，分析术后VTE（+）组和VTE（-）组临床病理因素的差异。进行单因素和多因素逻辑回归分析，以确定胃切除术后VTE的独立危险因素。
结果
在246例胃切除术后D-二聚体浓度升高的患者中，74例患者下肢/上肢静脉出现血栓形成。在术前因素中，术后VTE（+）组的年龄、白细胞水平、D-二聚体浓度和血糖水平显著更高。在术后因素中，术后VTE（+）组的血红蛋白水平显著更低。在病理因素中，肿瘤分期、浸润深度和TNM分类表明术后VTE（+）组的恶性程度更高。单因素逻辑回归分析表明年龄、术前血糖水平、术后血红蛋白水平、肿瘤分期、浸润深度和TNM分类是胃切除术后VTE的独立危险因素，而多因素逻辑回归分析显示年龄和肿瘤分期是胃切除术后VTE的独立危险因素。
结论
我们的研究表明，年龄、术前血糖水平、术后贫血和肿瘤恶性程度是GC患者胃切除术后发生VTE的独立危险因素。因此，围手术期对危险因素的监测、评估和管理对于胃切除术后取得更好的结果很重要。
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