【摘要】：目的:卵巢惡性腫瘤患者發(fā)生靜脈血栓栓塞(VTE)的風(fēng)險(xiǎn)較高,這不僅導(dǎo)致了患者在診斷和治療上花費(fèi)昂貴,而且嚴(yán)重威脅患者的生命健康。然而,關(guān)于卵巢癌患者合并靜脈血栓的相關(guān)高危因素及如何治療圍手術(shù)期合并靜脈血栓的卵巢癌患者方面,目前研究較少。因此,我們擬通過(guò)分析評(píng)估卵巢癌患者合并靜脈血栓栓塞(venous thromboembolism,VTE)發(fā)生的危險(xiǎn)因素,為圍手術(shù)期血栓的預(yù)防和治療提供參考。方法:本研究收集并回顧分析了山東大學(xué)齊魯醫(yī)院卵巢上皮性癌患者的臨床資料,研究的對(duì)象是自2014年1月1日到2017年1月1日于該院住院并接受化療和手術(shù)治療,最終病理確診為卵巢癌的患者。在本研究中,我們采用不同的統(tǒng)計(jì)方法分析這些患者的相關(guān)臨床因素,分析卵巢癌合并VTE的術(shù)前和術(shù)后相關(guān)危險(xiǎn)因素,探討如何在圍手術(shù)期治療和預(yù)防靜脈血栓栓塞。結(jié)果:在接受手術(shù)治療并最終確診為卵巢癌的388例患者中,有35例患者出現(xiàn)了VTE,其中包括術(shù)前VTE患者15例,術(shù)后發(fā)生VTE 20例,335的患者手術(shù)前后均未發(fā)生靜脈血栓,18例卵巢癌患者因臨床資料不完整而排除。在35例VTE形成患者中,確診為肺栓塞者共8例,其中包括術(shù)前PE 4例,術(shù)后4例(其中1例發(fā)生于術(shù)后5個(gè)月,腫瘤未控,發(fā)生肺栓塞和下肢靜脈栓塞),術(shù)后肺栓塞死亡1例,肺栓塞死亡率為12.5%,其余患者為不同部位的深靜脈血栓(DVT)。對(duì)4例術(shù)前發(fā)現(xiàn)肺栓塞的患者,我們于手術(shù)前給予了 2個(gè)周期的化療,同時(shí)用LMWH進(jìn)行抗凝治療。經(jīng)過(guò)這些處理后,4例肺栓塞患者癥狀消失,腹水情況好轉(zhuǎn),腫瘤腫塊大小明顯下降,之后對(duì)這4例患者均實(shí)施了滿意的腫瘤細(xì)胞減滅術(shù)。對(duì)患者的臨床相關(guān)因素用T檢驗(yàn)及x2檢驗(yàn)進(jìn)行分析后,我們發(fā)現(xiàn)血栓組和非血栓組在年齡、術(shù)前D-二聚體值、血小板數(shù)值、術(shù)前是否輔以新輔助化療、是否合并心血管疾病以及手術(shù)時(shí)間、術(shù)后是否應(yīng)用抗凝藥物等差別均有統(tǒng)計(jì)學(xué)意義(P0.05),通過(guò)多因素分析發(fā)現(xiàn),年齡55歲,術(shù)前D-二聚體值0.5ug/mml、血小板300*109/L、腫瘤直徑10cm是術(shù)前VTE發(fā)生的高危因素;D-二聚體值0.5ug/ml、手術(shù)時(shí)間150min是術(shù)后VTE發(fā)生的高危因素。結(jié)論:圍手術(shù)期發(fā)生VTE對(duì)卵巢癌患者可能造成致命性的嚴(yán)重后果,在婦科手術(shù)之前應(yīng)進(jìn)行積極的術(shù)前篩查,并積極采用圍手術(shù)期預(yù)防措施,尤其是對(duì)于存在這項(xiàng)研究中確定的風(fēng)險(xiǎn)因素的患者。對(duì)年齡較大、腫瘤較大、術(shù)前D-二聚體值或血小板數(shù)值較高的患者應(yīng)引起高度重視,減少手術(shù)時(shí)間及術(shù)后積極應(yīng)用抗凝藥物可預(yù)防深靜脈血栓形成。對(duì)于術(shù)前已經(jīng)發(fā)現(xiàn)VTE尤其是肺栓塞的卵巢癌患者,可先給予新輔助化療及抗凝藥物控制血栓進(jìn)展及癌灶發(fā)展,可提供更好的手術(shù)時(shí)機(jī),對(duì)患者的治療頗有必要。
[Abstract]:Objective: the risk of venous thromboembolism (VTE) in patients with malignant ovarian tumors is high, which not only leads to the high cost of diagnosis and treatment, but also seriously threatens the life and health of patients. However, there are few studies on the risk factors associated with venous thrombosis in patients with ovarian cancer and the treatment of ovarian cancer patients with venous thrombosis during perioperative period. Therefore, we intend to evaluate the risk factors of ovarian cancer patients with venous thromboembolism (venous thromboembolism,VTE) and provide reference for the prevention and treatment of perioperative thromboembolism. Methods: the clinical data of patients with ovarian epithelial carcinoma in Qilu Hospital of Shandong University were collected and analyzed retrospectively. The subjects of the study were hospitalized from January 1, 2014 to January 1, 2017, and received chemotherapy and surgical treatment. The final pathological diagnosis of ovarian cancer patients. In this study, we used different statistical methods to analyze the relevant clinical factors of these patients, to analyze the risk factors of ovarian cancer complicated with VTE before and after operation, and to explore how to treat and prevent venous thromboembolism in perioperative period. Results: of the 388 patients who underwent surgical treatment and were finally diagnosed with ovarian cancer, 35 had VTE, including 15 patients with preoperative VTE. No venous thrombosis occurred before and after operation in 20 patients with VTE and 18 patients with ovarian cancer were excluded because of incomplete clinical data. Among the 35 patients with VTE, 8 cases were diagnosed as pulmonary embolism, including 4 cases of preoperative PE, 4 cases of postoperative PE (1 case occurred 5 months after the operation, the tumor was not controlled, pulmonary embolism and venous embolism of lower extremity), and 1 case died of postoperative pulmonary embolism. The mortality rate of pulmonary embolism was 12.5. The rest of the patients had deep venous thrombosis (DVT).) at different sites. Four patients with pulmonary embolism before operation were treated with two cycles of chemotherapy and anticoagulant therapy with LMWH. After these treatments, the symptoms of 4 patients with pulmonary embolism disappeared, the ascites condition improved, and the tumor mass size decreased significantly. After that, satisfactory tumor cell reduction was performed in all of the 4 patients. After analyzing the clinical related factors of the patients by T test and x2 test, we found that the age, the preoperative D- dimer value, the platelet value and the preoperative neoadjuvant chemotherapy were found in the thrombus group and non-thrombotic group. There were significant differences in cardiovascular disease and operative time after operation and whether anticoagulant drugs were used after operation (P0.05). The age of 55 years was found by multivariate analysis. Preoperative D- dimer value was 0.5ug.mml, platelets was 300-109L, tumor diameter 10cm was the high risk factor of preoperative VTE. 150min was the high risk factor of postoperative VTE. Conclusion: perioperative VTE may cause fatal consequences for patients with ovarian cancer. Active preoperative screening should be carried out before gynecological surgery, and perioperative preventive measures should be used actively. This is especially true for patients with risk factors identified in this study. For the older patients with larger tumors and the higher preoperative D- dimer or platelet values, great attention should be paid to the prevention of deep venous thrombosis by reducing the operation time and actively applying anticoagulant drugs after operation. For ovarian cancer patients who have found VTE especially pulmonary embolism before operation, neoadjuvant chemotherapy and anticoagulant drugs can be given first to control the progression of thrombus and cancer focus, which can provide a better opportunity for operation and is necessary for the treatment of patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.31

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