【摘要】：目的探討胃癌圍手術(shù)期下肢深靜脈血栓形成的臨床特點(diǎn)和危險(xiǎn)因素。方法選擇我院胃腸外科2015年2月~2016年9月收治的胃癌患者167例,收集所有患者的臨床資料,將不符合入組標(biāo)準(zhǔn)的患者排除。按照有無下肢靜脈血栓形成分為有血栓組和無血栓組,選擇年齡、性別、職業(yè)、體重指數(shù)(body mass indexBMI)、吸煙、飲酒、手術(shù)方式、手術(shù)時(shí)間、術(shù)后用止血藥、術(shù)后感染或吻合口瘺、高血壓、糖尿病等可能影響胃癌圍手術(shù)期下肢DVT形成的因素進(jìn)行危險(xiǎn)因素分析,并建立模型,預(yù)測(cè)胃癌圍手術(shù)期患者的危險(xiǎn)層次。單因素分析采用卡方檢驗(yàn),多因素分析采用二分類Logistic多元回歸,設(shè)定P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果我院2015年2月-2016年9月收治的167例胃癌患者中,3例患者因臨床資料不完善或其他原因而被排除,164例患者入選。入選的164例患者中,下肢DVT的發(fā)病率為14.02%(23/164)。23例下肢DVT患者中,男14例(60.9%),女9例(39.1%);年齡27~82歲,平均年齡59.8±4.9歲;無臨床癥狀者19例(82.6%),有癥狀者4例(17.4%),無一例出現(xiàn)肺栓塞相關(guān)癥狀;血栓發(fā)生于左下肢10例(43.4%),右下肢6例(26.1%),雙下肢7例(30.4%);主要分布靜脈依次為小腿肌間靜脈19例(82.6%),腓靜脈3例(13.0%),脛后靜脈1例(4.3%)。通過單因素分析后,控制混雜因素,經(jīng)二分類多因素回歸分析得出年齡≥60歲、BMI≥25?kg/m2、高血壓(P??0.001)、術(shù)后并發(fā)癥(術(shù)后感染、吻合口瘺)、手術(shù)時(shí)間3.5小時(shí)、術(shù)后使用止血藥等是胃癌圍手術(shù)期獨(dú)立危險(xiǎn)因素。危險(xiǎn)等級(jí)預(yù)測(cè)模型:沒有相關(guān)危險(xiǎn)因素未發(fā)現(xiàn)下肢DVT患者,1個(gè)危險(xiǎn)因素的為4.8%,2個(gè)危險(xiǎn)因素的為27.88%,危險(xiǎn)因素≥3個(gè)的為43.75%。結(jié)論1、胃癌圍手術(shù)期下肢DVT發(fā)生率高,主要為無癥狀小腿肌間型血栓。左下肢較右下肢更容易形成。2、年齡≥60歲、高血壓、術(shù)后并發(fā)癥(術(shù)后感染、吻合口瘺)、術(shù)后使用止血藥、BMI≥25?kg/m2、手術(shù)時(shí)間3.5小時(shí)等是胃癌圍手術(shù)期發(fā)生下肢DVT的獨(dú)立危險(xiǎn)因素。3、針對(duì)發(fā)生下肢DVT的中、高危胃癌圍手術(shù)期患者,早期的診斷和預(yù)防,能夠降低其下肢DVT的發(fā)生率。
[Abstract]:Objective to investigate the clinical characteristics and risk factors of deep venous thrombosis in lower extremity during perioperative period of gastric cancer. Methods 167 patients with gastric cancer admitted in our hospital from February 2015 to September 2016 were selected and the clinical data of all patients were collected and excluded. Patients were divided into thrombus group and non-thrombus group. Age, sex, occupation, body mass index (body mass indexBMI),) smoking, drinking, operation time, postoperative hemostatic drugs were selected. Risk factors of postoperative infection or anastomotic fistula, hypertension and diabetes were analyzed to predict the risk level of gastric cancer perioperative patients. Single factor analysis using chi-square test, multivariate analysis using two-class Logistic multiple regression, set P0.05 as statistically significant. Results among 167 cases of gastric cancer treated in our hospital from February 2015 to September 2016, 3 cases were excluded because of incomplete clinical data or other reasons, 164 cases were selected. The incidence of lower extremity DVT was 14.02% (23 / 164) among the 164 patients, 14 (60.9%) were male and 9 (39.1%) were female, the average age was 59.8 鹵4.9 years old (2782 years), and 14 cases (60.9%) were male and 9 cases (39.1%) in lower extremity DVT. There were 19 cases (82.6%) without clinical symptoms and 4 cases (17.4%) with symptoms. Thrombosis occurred in 10 cases (43.4%) of the left lower limb, 6 cases (26.1%) of the right lower extremity and 7 cases (30.4%) of the bilateral lower limbs. The main distributed veins were the intermuscular vein of the leg in 19 cases (82.6%), the peroneal vein in 3 cases (13.0%) and the posterior tibial vein in 1 case (4.3%). After univariate analysis, the confounding factors were controlled, and the age 鈮，

本文編號(hào)：2371161