發(fā)布時(shí)間：2018-01-02 10:34

  本文關(guān)鍵詞：泌尿外科盆腔腫瘤大手術(shù)后發(fā)生靜脈血栓栓塞癥的臨床分析及防治體會(huì)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 泌尿系統(tǒng)腫瘤手術(shù) 靜脈血栓栓塞癥 膀胱癌 前列腺癌

【摘要】：目的:靜脈血栓栓塞癥(venous thromboembolism,VTE)是外科手術(shù)術(shù)后常見的嚴(yán)重并發(fā)癥之一,新發(fā)VTE在30天內(nèi)的死亡率很高。而前列腺癌和膀胱癌是主要的泌尿外科盆腔腫瘤,其發(fā)病率在我國也逐年升高。本文旨在通過收集我院泌尿外科盆腔腫瘤大手術(shù)(全膀胱切除術(shù)、前列腺癌根治術(shù))患者的臨床資料,了解術(shù)后VTE的發(fā)生率及影響因素,并總結(jié)圍手術(shù)期VTE的防治體會(huì)。方法:回顧性分析2010年01月至2016年12月期間在我院泌尿外科住院,確診為膀胱惡性腫瘤或前列腺惡性腫瘤并行全膀胱切除術(shù)或前列腺癌根治術(shù)患者的臨床資料。了解術(shù)后VTE的發(fā)生率及圍手術(shù)期采用Capirin靜脈血栓評估模型及相應(yīng)預(yù)防措施前后VTE的發(fā)生率變化。統(tǒng)計(jì)分析患者及手術(shù)相關(guān)影響因素對術(shù)后發(fā)生VTE的影響。同時(shí),檢索VTE相關(guān)防治指南及文獻(xiàn)總結(jié)泌尿外科VTE的防治體會(huì)。結(jié)果:根據(jù)本研究的納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),入組共316例患者。其中全膀胱切除術(shù)180例,平均年齡68.4±11.6(38-91)歲;平均BMI 24.0±3.1(19.0-32.1)Kg/m2。其中腹腔鏡手術(shù)124例(68.9%),開放手術(shù)56例(31.1%)。平均手術(shù)時(shí)間312.6±97.1(140-600)min;平均手術(shù)出血592.4±492.8(50-2500)ml;圍手術(shù)期輸血56例(31.1%);術(shù)中伴清掃盆腔淋巴結(jié)157例(87.2%)。前列腺癌根治性手術(shù)136例,平均年齡71.0±7.2(52-86)歲;平均BMI 25.2±2.8(20.6-34.1)Kg/m2。其中腹腔鏡手術(shù)110例(80.9%),開放手術(shù)26例(19.1%)。平均手術(shù)時(shí)間216.6±76.4(60-420);平均手術(shù)出血500.7±636.6(30-4000)ml;圍手術(shù)期輸血23例(16.9%);術(shù)中伴清掃盆腔淋巴結(jié)57例(41.9%)。術(shù)后30天內(nèi)新發(fā)有癥狀的VTE 6例,總發(fā)生率為1.9%;其中發(fā)生下肢深靜脈血栓6例(1.9%),肺栓塞1例(0.3%),1例患者同時(shí)合并下肢深靜脈血栓和肺栓塞,平均發(fā)生于術(shù)后的7.7±5.6(1-16)天;其中全膀胱切除術(shù)VTE發(fā)生率為2.2%(4/180),前列腺癌根治術(shù)VTE發(fā)生率為1.5%(2/136)。本組研究中,術(shù)中伴盆腔淋巴結(jié)清掃增加了術(shù)后VTE的發(fā)生,圍手術(shù)期輸血、腫瘤分期、手術(shù)時(shí)間(4h)等對術(shù)后發(fā)生VTE的影響無統(tǒng)計(jì)學(xué)意義(P0.05)。將Caprini靜脈血栓評估模型用于泌尿外科盆腔腫瘤大手術(shù)圍手術(shù)期VTE評估及預(yù)防前后對比,減少了術(shù)后VTE的發(fā)生(P0.05,差異有統(tǒng)計(jì)學(xué)意義)。結(jié)論:泌尿外科盆腔腫瘤大手術(shù)后30天內(nèi)新發(fā)有癥狀VTE的發(fā)生率為1.9%。本研究中,全膀胱切除術(shù)后VTE發(fā)生率較前列腺癌根治術(shù)高(2.2%VS 1.5%),術(shù)中伴盆腔淋巴結(jié)清掃與術(shù)后VTE的發(fā)生明顯相關(guān)。Caprini靜脈血栓評估模型用于泌尿外科盆腔腫瘤大手術(shù)圍手術(shù)期VTE評估及預(yù)防,有效的預(yù)測了術(shù)后VTE發(fā)生的風(fēng)險(xiǎn),減少了術(shù)后VTE的發(fā)生率。但是目前,針對泌尿外科手術(shù)專有VTE風(fēng)險(xiǎn)評估量表及預(yù)防指南仍是目前研究的方向。
[Abstract]:Objective: venous thromboembolism (venous thromboembolism VTE) is one of the common and serious complication after surgery, new VTE within 30 days. The mortality rate is high and the bladder and prostate cancer is mainly the Department of Urology of pelvic tumors, and its incidence is rising year by year in China. This paper aimed to collect our Hospital Department of Urology, pelvic tumor surgery (radical cystectomy, prostatectomy) in patients with clinical data, to understand the incidence and influencing factors of postoperative VTE, and summarize the experience of prevention and treatment of perioperative VTE. Methods: a retrospective analysis of hospitalized in the Department of Urology of our hospital in 2010 01 months to December 2016, diagnosed with bladder cancer or prostate cancer clinical data parallel cystectomy or radical prostatectomy for prostate cancer patients. To understand the incidence of postoperative VTE and perioperative venous thrombosis by Capirin evaluation model and phase Prevention measures before and after the VTE rate changes. Statistics related factors of patients and operation analysis of the impact on the occurrence of VTE after operation. At the same time, experience the retrieval of VTE related literature summary and the guidelines for prevention and treatment of Department of Urology, prevention and treatment of VTE. Results: according to the inclusion criteria and exclusion criteria, into the group of 316 patients. The whole bladder resection in 180 cases, the average age of 68.4 + 11.6 (38-91); the average BMI 24 + 3.1 (19.0-32.1) Kg/m2. in laparoscopic surgery in 124 cases (68.9%), 56 cases of open surgery (31.1%). The average operation time was 312.6 + 97.1 (140-600) min; the average bleeding 592.4 + 492.8 (50-2500) ml; perioperative blood transfusion in 56 cases (31.1%); patients with pelvic lymph node dissection in 157 cases (87.2%). Prostate cancer radical surgery in 136 cases, the average age of 71 + 7.2 (52-86); the average BMI 25.2 + 2.8 (20.6-34.1) Kg/m2. in laparoscopic surgery in 110 cases (80.9%), 26 cases of open surgery (19.1 %).騫沖潎鎵嬫湳鏃墮棿216.6鹵76.4(60-420);騫沖潎鎵嬫湳鍑鴻500.7鹵636.6(30-4000)ml;鍥存墜鏈湡杈撹23渚，

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