【摘要】： 目的：通過研究喉癌、喉咽癌患者圍手術(shù)期血漿D-二聚體的動態(tài)變化規(guī)律來評價血漿D-二聚體對早期排除肺栓塞的價值。 方法：對42例喉癌、喉咽癌患者的術(shù)前及術(shù)后第1、3、7、10天血漿D-二聚體水平進行分析。其中包括32例喉癌,10例喉咽癌。均為男性,平均年齡(59.7±8.0)歲,術(shù)前均無頸部手術(shù)史及放療史；喉癌組中包括聲門上型3例,聲門型29例；Ⅰ期4例,Ⅱ期13例,Ⅲ期10例，，Ⅳ期5例；T1N0M04例、T2N0M013例、T2N1M02例、T3N0M05例、T3N1M03例、T4N1M02例、T4N2M02例、T4N3M01例；喉咽癌組患者10例,包括Ⅲ期4例,Ⅳ期6例,T2N1M02例、T2N2M01例、T3N0M01例、T3N1M01例、T3N2M03例、T4N2M02例。對照組18例,包括11例聲帶息肉患者,7例會1厭囊腫患者,平均年齡(53.5±7.5)歲。 喉癌、喉咽癌組于術(shù)前、術(shù)后第1、3、7、10天清晨采集空腹外周靜脈血,于1小時內(nèi)室溫轉(zhuǎn)運并檢測血漿D-二聚體。對照組只采集術(shù)前外周靜脈血,余與喉癌、喉咽癌組相同。 結(jié)果：對照組與喉癌、喉咽癌組術(shù)前血漿D-二聚體水平存在差異,有統(tǒng)計學(xué)意義(t=1.663,P=0.017＜0.05)。喉癌、喉咽癌組中,喉癌與喉咽癌患者術(shù)前血漿D-二聚體水平差異沒有統(tǒng)計學(xué)意義(t=1.036，P=0.110.05)；喉癌、喉咽癌組術(shù)后血漿D-二聚體明顯升高,與術(shù)前相比較,差異有統(tǒng)計學(xué)意義(q=3.3917-7.4354,P0.05-0.01)；合并心血管系統(tǒng)疾病患者與不合并心血管系統(tǒng)疾病的患者相比,術(shù)前、術(shù)后第7天及術(shù)后第10天血漿D-二聚體水平差異存在統(tǒng)計學(xué)意義(t=0.376-3.023,P=0.000-0.050≤0.05)；合并糖尿病患者組與不合并糖尿病的患者組相比,術(shù)前、術(shù)后第1天、術(shù)后第10天血漿D-二聚體水平存在統(tǒng)計學(xué)差異(t=1.247-1.725,P=0.005-0.009＜0.05)；該組是否同期進行頸清掃術(shù)對術(shù)后血漿D-二聚體水平無明顯影響；是否同時有頸淋巴結(jié)轉(zhuǎn)移對血漿D-二聚體水平無影響；Ⅰ、Ⅱ期喉癌、喉咽癌患者術(shù)后第7天血漿D-二聚體水平高于Ⅲ、Ⅳ期患者,差異有統(tǒng)計學(xué)意義(t=0.797,P=0.047＜0.05)。所有患者術(shù)前D-二聚體水平均與年齡存在相關(guān)。 結(jié)論：①喉癌、喉咽癌患者術(shù)前血漿D-二聚體水平增高；②喉癌、喉咽癌患者術(shù)后第1-10天血漿D-二聚體水平較術(shù)前進一步增高,血漿D-二聚體檢測可作為喉癌、喉咽癌患者術(shù)后可疑肺栓塞患者的篩查手段；③合并心血管疾病、糖尿病的喉癌、喉咽癌患者手術(shù)前后血漿D-二聚體水平進一步增高。
[Abstract]:Objective: To evaluate the value of plasma D-dimer in early exclusion of pulmonary embolism by studying the dynamic changes of plasma D-dimer in patients with laryngeal and laryngopharyngeal carcinoma during perioperative period.
Methods: The plasma D-dimer levels of 42 patients with laryngeal cancer and laryngopharyngeal cancer were analyzed before operation and on the 1st, 3rd, 7th and 10th day after operation, including 32 patients with laryngeal cancer and 10 patients with laryngopharyngeal cancer. There were 10 cases of stage III, 10 cases of stage III, and 5 cases of stage IV; 10 cases of stage III, 10 cases of stage III, 10 cases of stage III, 6 cases of stage IV, 6 cases of stage T2N1M02, 2 cases of T2N0M02, 13 cases of T1N0M01, 13 cases of T2N1M02, 23 cases of T2N1M02, T3NN2M02, T3N1M03 cases of T3N1M03, T4NN2M02 cases of T4N2M02, T4N2M02 cases of T4N2M02, T4N3N3N2M02 cases, T4N2M02 cases of patients of laryand pharynpharynpharynpharyncarcinoma, including 4 cases of stage III, 6 cases of stage IV, 6 cases of stage IV, 6 cases of bursa The average age of the patients was (53.5 + 7.5) years.
The fasting peripheral venous blood was collected before operation, 1,3,7,10 days after operation in the laryngopharyngeal cancer group, and transported at room temperature within 1 hour to detect plasma D-dimer.
Results: There were significant differences in plasma D-dimer levels between the control group and the laryngopharyngeal cancer group (t = 1.663, P = 0.017 < 0.05). There was no significant difference in plasma D-dimer levels between the laryngopharyngeal cancer group and the laryngopharyngeal cancer group (t = 1.036, P = 0.110.05). The levels of plasma D-dimer were significantly higher in patients with cardiovascular diseases than those without cardiovascular diseases before operation, 7 days after operation and 10 days after operation (t = 0.376-3.023, P = 0.000-0.050 < 0.05). There were significant differences in plasma D-dimer levels between the patients with urinary disease and those without diabetes mellitus before operation, on the first day after operation and on the tenth day after operation (t = 1.247-1.725, P = 0.005-0.009 < 0.05). Plasma D-dimer levels were not affected; D-dimer levels in patients with stage I, II laryngopharyngeal carcinoma were higher than those in stage III and IV on the 7th day after surgery (t = 0.797, P = 0.047 < 0.05). Preoperative D-dimer levels were correlated with age in all patients.
Conclusion: The plasma D-dimer levels in patients with laryngopharyngeal carcinoma and laryngopharyngeal carcinoma before operation are higher than those before operation. The plasma D-dimer levels in patients with laryngopharyngeal carcinoma and laryngopharyngeal carcinoma after operation are further higher than those before operation. The level of plasma D- two dimer in laryngeal and hypopharyngeal cancer patients increased further before and after operation.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R739.6

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