本文選題：子宮內(nèi)膜癌 + 深靜脈血栓��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:回顧性分析我院和我院合作醫(yī)院(菏澤市市立醫(yī)院)子宮內(nèi)膜癌患者圍手術期發(fā)生血栓的相關高危因素,為圍手術期血栓的有效預防提供有價值的參考。方法:收集2010年6月-2016年12月期間因子宮內(nèi)膜癌于我院和我院合作醫(yī)院(菏澤市市立醫(yī)院)行婦科手術治療患者病例共計564例,其中術后12天內(nèi)發(fā)生下肢深靜脈血栓的患者23例(發(fā)病率為4.08%),選擇同期未發(fā)生下肢深靜脈血栓的子宮內(nèi)膜癌手術患者541例,并按1:20的比例隨機選擇26例作為對照組,研究指標包括年齡、體重指數(shù)、合并癥(糖尿病、高血壓、高血脂、心臟病及口服激素類藥物史)、腫瘤分期、術后化療或使用止血藥物、手術前后血常規(guī)、凝血功能、血脂等。分析不同的臨床病理參數(shù)、手術方式、手術范圍、手術時間等與子宮內(nèi)膜癌圍手術期血栓發(fā)生的關系。血栓的診斷通過檢查患者下肢情況及多普勒超聲診斷等綜合判斷靜脈血栓的發(fā)生情況。結果:子宮內(nèi)膜癌患者圍手術期發(fā)生血栓的年齡段多集中在40-59歲,隨著年齡的增長,圍手術期發(fā)生深靜脈血栓的概率明顯增加。血栓組體重指數(shù)顯著高于對照組,分別為26.15±3.76 kg/m2與23.93±3.62 kg/m2(P=0.0408)。術前若有長期臥床史也增加了圍手術期深靜脈血栓發(fā)生的概率。血栓組合并癥(包括糖尿病、高血壓、高血脂、心臟病及口服激素類藥物史)的數(shù)量和比例明顯高于對照組。腫瘤分期對血栓形成有顯著性影響(P=0.012),隨著腫瘤時期的進展,血栓的發(fā)生率顯著提高。血栓組術后紅細胞壓積值(0.32±0.065 L/L)顯著低于術前(0.39±0.052 L/L);纖維蛋白原含量較對照組顯著增高(分別為4.57±1.25g/L,2.73±0.81g/L)。而血栓組的高密度脂蛋白膽固醇含量明顯低于對照組(分別為1.12±0.27mmol/L和1.46±0.31mmol/L,P=0.0002)。腫瘤晚期患者纖維蛋白原及血漿D-二聚體含量明顯高于早期患者。手術時間越長,血栓發(fā)生的風險越高(2h、3h、4h及4h以上的患者血栓發(fā)生率分別為0.92%、5.91%、10.53%和28.99%)。隨著手術范圍的擴大,患者深靜脈血栓的發(fā)生率顯著提高。術后化療或使用止血藥也顯著提高了子宮內(nèi)膜癌圍術期血栓的發(fā)生。結論:年齡、體重指數(shù)、合并癥、手術時間、手術方式、腫瘤分期及術后化療或使用止血藥物為子宮內(nèi)膜癌圍手術期血栓發(fā)生的高危因素。
[Abstract]:Objective: to analyze the risk factors of perioperative thrombus in patients with endometrial carcinoma in our hospital and Heze City Hospital, so as to provide valuable reference for the effective prevention of perioperative thrombus. Methods: from June 2010 to December 2016, 564 cases of endometrial carcinoma were treated by gynecological surgery in our hospital and Heze City Hospital. Among them, 23 cases (incidence rate 4.08) of deep venous thrombosis of lower extremity occurred within 12 days after operation, 541 cases of endometrial carcinoma without lower extremity deep vein thrombosis were selected in the same period, and 26 cases were randomly selected as control group according to the proportion of 1:20. These include age, body mass index, complications (diabetes, hypertension, hyperlipidemia, heart disease and oral steroids), tumor staging, postoperative chemotherapy or use of hemostatic drugs, preoperative and postoperative blood routine, coagulation function, and blood lipids. To analyze the relationship between different clinicopathological parameters, surgical methods, surgical scope and operative time and perioperative thrombogenesis of endometrial carcinoma. In the diagnosis of thrombosis, the occurrence of venous thrombosis was judged by examination of lower extremity and Doppler ultrasound. Results: the age of perioperative thrombosis in patients with endometrial carcinoma was mainly 40-59 years old. With the increase of age, the probability of deep venous thrombosis in perioperative period increased significantly. The BMI of thrombus group was significantly higher than that of the control group (26.15 鹵3.76 kg/m2 and 23.93 鹵3.62 kg / m ~ (-2) 路min ~ (-2)) respectively. Long-term history of bed-rest before operation also increased the risk of perioperative deep venous thrombosis. The number and proportion of complications (including diabetes, hypertension, hyperlipidemia, heart disease and oral hormone history) in thrombus group were significantly higher than those in control group. Tumor staging had a significant effect on thrombosis. With the progression of tumor stage, the incidence of thrombus increased significantly. In the thrombus group, the hematocrit value was 0.32 鹵0.065 L / L and the fibrinogen content was significantly higher than that in the control group (4.57 鹵1.25 g / L, 2.73 鹵0.81g / L, respectively). However, the high density lipoprotein cholesterol content in the thrombus group was significantly lower than that in the control group (1.12 鹵0.27mmol/L and 1.46 鹵0.31 mmol / L, 0.0002, respectively). The levels of fibrinogen and plasma D-dimer in patients with advanced tumor were significantly higher than those in early patients. The longer the operation time, the higher the risk of thrombosis. The incidence of thrombus in the patients with 2 h or 3 h and more than 4 h was 0.92% and 28.99%, respectively. With the expansion of the scope of surgery, the incidence of deep venous thrombosis increased significantly. Postoperative chemotherapy or the use of hemostatic drugs also significantly increased the incidence of perioperative thrombus in endometrial carcinoma. Conclusion: age, body mass index (BMI), complications, operative time, operative method, tumor staging and postoperative chemotherapy or use of hemostatic drugs are the risk factors for perioperative thrombosis of endometrial carcinoma.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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