Gao Wenbo, Ye Haihong, Xu Yangkai
Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo City, Zhejiang, China.
Front Med (Lausanne). 2025 Jul 7;12:1623198. doi: 10.3389/fmed.2025.1623198. eCollection 2025.
Venous thromboembolism (VTE) is serious in elderly patients undergoing laparoscopic radical cystectomy and bilateral pelvic lymph node dissection. We compared the results of two VTE prophylaxis protocols: dynamic D-dimer measurement in combination with ultrasonography screening in Experimental Group (EG), and conventional VTE prophylaxis in historical control group (HCG).
Between January 2022 and January 2024, the elderly patients undergoing such surgeries in EG received dynamic measurement of plasma D-dimer at admission and at 1, 3, 7, and 14 days after surgery in combination with ultrasonography screening, and commensurate VTE mechanical prophylaxis measures. Between January 2019 and December 2021, elderly patients in HCG underwent conventional prophylaxis and mechanical measures. And they were observed carefully for VTE symptoms, with Doppler ultrasonography being performed only in patients with clinical suspicion for VTE. The incidence of VTE event, major postoperative complications, major bleeding rate, and evaluation of activities of daily living within 30 days postoperatively were compared.
The preoperative and intraoperative parameters were similar between the two groups. In EG, dynamic D-dimer measurements revealed a distinct temporal declining pattern. In HCG, VTE was detected in five patients out of 98 patients (5/98, 4.08%); and in EG, eight patients were found to have DVT (8/109, 7.34%; = 0.04). The incidence of symptomatic VTE was significantly lower in EG than in HCG (one and five cases, respectively, 0.9% vs. 5.1%, = 0.04), and the incidence of postoperative asymptomatic VTE was higher in the EG than in the HCG (seven and 0 cases, respectively, 6.4% vs. 0%). The incidence of major complications was similar between the two groups ( = 0.61), with similar result regarding the incidence of major bleeding ( = 0.55). The average Barthel index score in EG was 81.0 points, significantly higher than 78.3 points of the HCG ( = 0.03), and the result demonstrated a faster recovery of activities of daily living in the Experimental Group.
Our results demonstrated that postoperative dynamic D-dimer and ultrasonography measurement in elderly patients can better monitor the risk of VTE, identify asymptomatic thrombosis at an early stage, optimize the timing of intervention and improve clinical outcomes, without resulting in more complications or major bleeding. Elderly patients undergoing laparoscopic radical cystectomy could benefit from such strategies.
静脉血栓栓塞症（VTE）在接受腹腔镜根治性膀胱切除术和双侧盆腔淋巴结清扫术的老年患者中较为严重。我们比较了两种VTE预防方案的结果：实验组（EG）采用动态D-二聚体检测联合超声筛查，历史对照组（HCG）采用传统的VTE预防措施。
2022年1月至2024年1月，EG组中接受此类手术的老年患者在入院时以及术后第1、3、7和14天接受血浆D-二聚体动态检测，并联合超声筛查，同时采取相应的VTE机械预防措施。2019年1月至2021年12月，HCG组老年患者接受传统预防和机械措施。仔细观察他们是否有VTE症状，仅对临床怀疑有VTE的患者进行多普勒超声检查。比较两组VTE事件的发生率、术后主要并发症、大出血率以及术后30天内的日常生活活动评估情况。
两组患者术前和术中参数相似。在EG组中，动态D-二聚体检测显示出明显的时间下降模式。在HCG组中，98例患者中有5例检测到VTE（5/98，4.08%）；在EG组中，8例患者被发现有深静脉血栓形成（8/109，7.34%；P = 0.04）。EG组有症状VTE的发生率显著低于HCG组（分别为1例和5例，0.9%对5.1%，P = 0.04），EG组术后无症状VTE的发生率高于HCG组（分别为7例和0例，6.4%对0%）。两组主要并发症的发生率相似（P = 0.61），大出血发生率的结果也相似（P = 0.55）。EG组的平均Barthel指数评分为81.0分，显著高于HCG组的78.3分（P = 0.03），结果表明实验组日常生活活动恢复更快。
我们的结果表明，老年患者术后动态D-二聚体和超声检测可以更好地监测VTE风险，早期识别无症状血栓形成，优化干预时机并改善临床结局，且不会导致更多并发症或大出血。接受腹腔镜根治性膀胱切除术的老年患者可从这些策略中获益。
