Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, China.
Department of Thoaracic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, China.
Asian J Surg. 2023 Sep;46(9):3648-3655. doi: 10.1016/j.asjsur.2023.02.015. Epub 2023 Feb 14.
To investigate venous thromboembolism (VTE) in patients undergoing distal cholangiocarcinoma (dCCA) surgery, we performed a single-center study to assess its prevalence, risk factors, prognosis.
We studied a total of 177 patients undergoing dCCA surgery from January 2017 to April 2022. Demographic, clinical data, laboratory data (including lower extremity ultrasound findings), and outcome variables were obtained, and compared between VTE and non-VTE groups.
Of the 177 patients undergoing dCCA surgery (aged 65.2 ± 9.6 years; 108 (61.0%) male), 64 patients developed VTE after surgery. Logistic multivariate analysis showed that, age, operation procedure, TNM stage, ventilator duration and preoperative D-dimer were independent risk factors. Based on these factors, we constructed the nomogram to predict VTE after dCCA for the first time. The areas under the receiver operating curve (ROC) of the nomogram were 0.80 (95% CI: 0.72-0.88) and 0.79 (95% CI: 0.73-0.89) in the training and validation groups, respectively. Patients developed VTE had a worse prognosis by Kaplan-Meier curve analysis (p = 0.001).
The prevalence of VTE is high and is associated with adverse outcomes in patients undergoing dCCA surgery. We developed a nomogram assessing VTE risk, which may help clinicians to screen out people at high risk for VTE and to undertake rational preventive measures.
为了研究接受远端胆管癌（dCCA）手术的患者中的静脉血栓栓塞症（VTE），我们进行了一项单中心研究，以评估其患病率、危险因素和预后。
我们研究了 2017 年 1 月至 2022 年 4 月期间接受 dCCA 手术的 177 例患者。收集了人口统计学、临床数据、实验室数据（包括下肢超声结果）和结局变量，并在 VTE 和非 VTE 组之间进行了比较。
在接受 dCCA 手术的 177 例患者中（年龄 65.2±9.6 岁；108 例男性，占 61.0%），术后有 64 例发生 VTE。Logistic 多因素分析显示，年龄、手术方式、TNM 分期、呼吸机使用时间和术前 D-二聚体是独立的危险因素。基于这些因素，我们首次构建了预测 dCCA 术后 VTE 的列线图。列线图在训练组和验证组中的受试者工作特征曲线（ROC）下面积分别为 0.80（95%可信区间：0.72-0.88）和 0.79（95%可信区间：0.73-0.89）。Kaplan-Meier 曲线分析显示，发生 VTE 的患者预后较差（p=0.001）。
dCCA 手术患者 VTE 的患病率较高，与不良预后相关。我们开发了一种评估 VTE 风险的列线图，这可能有助于临床医生筛选出 VTE 风险较高的人群，并采取合理的预防措施。
