|
预防妇科肿瘤术后VTE研究进展
|
Abstract:
妇科肿瘤严重危害着女性健康,由于妇科手术多位于盆腔,术中多需要采取截石位,加上肿瘤可直接或间接激活凝血系统,使得妇科肿瘤术后静脉血栓发生率明显高于其他疾病,因此能够正确识别并采取合适的预防措施,是VTE诊疗中的关键。本文就VTE的研究现状进行了综述,客观阐述现存问题,联合目前研究现状,以期为临床的诊疗提供参考和依据。
Gynecological tumors seriously endanger women’s health. Gynecological surgery is mostly located in the pelvic cavity, and the lithotomy position is often needed during the operation. In addition, the tumor can directly or indirectly activate the coagulation system, so that the incidence of venous thrombosis after gynecological tumor surgery is significantly higher than that of other diseases. Therefore, it is the key to correctly identify and take appropriate preventive measures in the diagnosis and treatment of VTE. This article reviews the research status of VTE, objectively expounds the existing problems, and combines the current research status to provide reference and basis for clinical diagnosis and treatment.
[1] | 郎景和, 王辰, 瞿红, 等. 妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J]. 中华妇产科杂志, 2017, 52(10): 649-653. |
[2] | 崔代政, 叶絮. 第417号指南: 妇科手术中静脉血栓栓塞性疾病的预防的解读[J]. 血栓与止血学, 2023, 29(1): 5-11. |
[3] | 王佳晰, 于浩, 张师前. 妇科肿瘤患者围手术期静脉血栓栓塞症预防的专家共识(2022年版) [J]. 中华肿瘤防治杂志, 2022, 29(10): 687-694. |
[4] | 吴洲鹏, 赵纪春, 马玉奎, 等. 老年人静脉血栓栓塞症的研究进展[J]. 中国普外基础与临床杂志, 2018, 25(8): 1004-1010. |
[5] | Qu, H., Li, Z., Zhai, Z., Liu, C., Wang, S., Guo, S., et al. (2015) Predicting of Venous Thromboembolism for Patients Undergoing Gynecological Surgery. Medicine, 94, e1653. https://doi.org/10.1097/md.0000000000001653 |
[6] | Ma, S., Hu, J. and Huang, Y. (2020) The Risk Factors for Perioperative Venous Thromboembolism in Patients with Gynecological Malignancies: A Meta-Analysis. Thrombosis Research, 196, 325-334. https://doi.org/10.1016/j.thromres.2020.09.019 |
[7] | Pan, J. and Zhao, G. (2024) Meta-Analysis of Risk Factors for Venous Thromboembolism in Patients with Gynecologic Malignant Tumors. Alternative Therapies in Health and Medicine. |
[8] | Anderson, F.A. and Spencer, F.A. (2003) Risk Factors for Venous Thromboembolism. Circulation, 107, I-9-I-16. https://doi.org/10.1161/01.cir.0000078469.07362.e6 |
[9] | Ageno, W., Becattini, C., Brighton, T., Selby, R. and Kamphuisen, P.W. (2008) Cardiovascular Risk Factors and Venous Thromboembolism. Circulation, 117, 93-102. https://doi.org/10.1161/circulationaha.107.709204 |
[10] | Mahmoodi, B.K., Cushman, M., Anne N?ss, I., Allison, M.A., Bos, W.J., Br?kkan, S.K., et al. (2017) Association of Traditional Cardiovascular Risk Factors with Venous Thromboembolism: An Individual Participant Data Meta-Analysis of Prospective Studies. Circulation, 135, 7-16. https://doi.org/10.1161/circulationaha.116.024507 |
[11] | Bakirhan, K. and Strakhan, M. (2012) Pharmacologic Prevention of Venous Thromboembolism in Obese Patients. Journal of Thrombosis and Thrombolysis, 36, 247-257. https://doi.org/10.1007/s11239-012-0844-1 |
[12] | 熊爱莉. 妇科恶性肿瘤术后静脉血栓形成的风险因素分析[D]: [硕士学位论文]. 南宁: 广西医科大学, 2019. |
[13] | 李晓娟. 围手术期干预对具有高危因素妇科手术患者下肢深静脉血栓形成的预防效果研究[J]. 现代中西医结合杂志, 2015, 24(32): 3629-3631. |
[14] | 黄小红, 管玉梅, 吴泉玲, 等. 压力带与抗栓泵联合使用预防妇科盆腔手术患者下肢深静脉血栓的研究[J]. 护理管理杂志, 2013, 13(7): 523-525. |
[15] | Moulder, J.K., Moore, K.J., Strassle, P.D. and Louie, M. (2021) Effect of Length of Surgery on the Incidence of Venous Thromboembolism after Benign Hysterectomy. American Journal of Obstetrics and Gynecology, 224, 364.e1-364.e7. https://doi.org/10.1016/j.ajog.2020.10.007 |
[16] | Connolly, G.C. and Khorana, A.A. (2010) Emerging Risk Stratification Approaches to Cancer-Associated Thrombosis: Risk Factors, Biomarkers and a Risk Score. Thrombosis Research, 125, S1-S7. https://doi.org/10.1016/s0049-3848(10)00227-6 |
[17] | 李逃明, 杨名宇, 胡林, 等. 妇科恶性肿瘤住院患者并发静脉血栓栓塞的影响因素研究[J]. 中国医学工程, 2019, 27(2): 30-35. |
[18] | Goldhaber, S.Z. and Bounameaux, H. (2012) Pulmonary Embolism and Deep Vein Thrombosis. The Lancet, 379, 1835-1846. https://doi.org/10.1016/s0140-6736(11)61904-1 |
[19] | American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Gynecology (2021) Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics & Gynecology, 138, e1-e15. |
[20] | 赖月容, 姜月, 蒋超南, 等. Caprini静脉血栓风险评估量表预测妇科恶性肿瘤患者手术后静脉血栓形成及风险模型构建[J]. 实用妇产科杂志, 2021, 37(12): 918-923. |
[21] | Guo, T., Li, M., Sang, C., Zhang, Z., Guo, R., Lu, R., et al. (2022) Validation of Two Risk Assessment Models for Venous Thromboembolism in Patients Undergoing Gynecologic Surgery. Annals of Translational Medicine, 10, 18. https://doi.org/10.21037/atm-21-6284 |
[22] | Kearon, C., Akl, E.A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., et al. (2016) Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest, 149, 315-352. https://doi.org/10.1016/j.chest.2015.11.026 |
[23] | Einstein, M.H., Pritts, E.A. and Hartenbach, E.M. (2007) Venous Thromboembolism Prevention in Gynecologic Cancer Surgery: A Systematic Review. Gynecologic Oncology, 105, 813-819. https://doi.org/10.1016/j.ygyno.2007.03.004 |
[24] | 赵玲玲, 杨茜, 邓国瑜, 等. 妇科恶性肿瘤患者术后深静脉血栓的非药物预防研究进展[J]. 癌症进展, 2021, 19(1): 14-18. |
[25] | 潘聪桃, 黄宝钗, 黄晓敏, 等. 术中间歇充气加压装置对老年妇科肿瘤患者术后下肢深静脉血栓的预防作用[J]. 中国妇幼保健, 2022, 37(18): 3472-3475. |
[26] | 杨晶慧, 甘秀妮, 李钱玲, 等. 髋关节置换术后间歇充气加压装置最佳使用时间的随机对照研究[J]. 护理研究, 2020, 34(5): 778-783. |
[27] | Moffatt, C. (2008) Variability of Pressure Provided by Sustained Compression. International Wound Journal, 5, 259-265. https://doi.org/10.1111/j.1742-481x.2008.00470.x |
[28] | 中国微循环学会周围血管疾病专业委员会压力学组. 血管压力治疗中国专家共识(2021版) [J]. 中华医学杂志, 2021, 101(17): 1214-1225. |
[29] | Bj?rnar?, B.T., Gudmundsen, T.E. and Dahl, O.E. (2006) Frequency and Timing of Clinical Venous Thromboembolism after Major Joint Surgery. The Journal of Bone and Joint Surgery. British Volume, 88, 386-391. https://doi.org/10.1302/0301-620x.88b3.17207 |
[30] | 龚敏, 柳蓉, 陈维强, 等. 术中GCS联合足底动静脉泵干预预防妇科肿瘤患者术后下肢深静脉血栓的效果观察[J]. 罕少疾病杂志, 2023, 30(10): 74-75, 83. |
[31] | Ageno, W., Casella, I.B., Han, C.K., Raskob, G.E., Schellong, S., Schulman, S., et al. (2017) RE-COVERY DVT/PE: Rationale and Design of a Prospective Observational Study of Acute Venous Thromboembolism with a Focus on Dabigatran Etexilate. Thrombosis and Haemostasis, 117, 415-421. https://doi.org/10.1160/th16-07-0566 |
[32] | Kohro, S., Yamakage, M., Takahashi, T., Kondo, M., Ota, K. and Namiki, A. (2002) Intermittent Pneumatic Compression Prevents Venous Stasis in the Lower Extremities in the Lithotomy Position. Canadian Journal of Anesthesia, 49, 144-147. https://doi.org/10.1007/bf03020486 |
[33] | 甘洪方. 马镫形多功能腿架在妇产科经阴道手术中的应用[J]. 医疗装备, 2022, 35(9): 109-111. |
[34] | 张哲, 吕浩, 谢倩. 马镫形腿架在腔镜下子宫内膜癌根治术的应用研究[J]. 河北医科大学学报, 2016, 37(2): 219-221. |
[35] | Xiong, Y., Zhao, T. and Li, C. (2024) Application Value of Extreme Flexion and Abduction Hip Combined with Stirrup-Shaped Multifunctional Leg Frame in Blocking Obturator Nerve Reflex in Transurethral Resection of Bladder Tumor. International Urology and Nephrology. https://doi.org/10.1007/s11255-024-03997-8 |
[36] | 冯建萍, 张彬, 傅士龙, 等. 动态调节截石位对术中妇科盆腔肿瘤患者下肢血流动力学的影响[J]. 南京医科大学学报(自然科学版), 2021, 41(2): 230-233. |
[37] | 岑志富, 陈玉华, 崔凯军. 新型口服抗凝剂出血并发症的治疗[J]. 华西医学, 2017, 32(6): 931-935. |
[38] | Key, N.S., Khorana, A.A., Kuderer, N.M., Bohlke, K., Lee, A.Y.Y., Arcelus, J.I., et al. (2020) Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer: ASCO Clinical Practice Guideline Update. Journal of Clinical Oncology, 38, 496-520. https://doi.org/10.1200/jco.19.01461 |
[39] | Streiff, M.B., Holmstrom, B., Angelini, D., et al. (2021) Cancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 19, 1181-1201. |
[40] | Kakkos, S.K., Caprini, J.A., Geroulakos, G., Nicolaides, A.N., Stansby, G., Reddy, D.J., et al. (2016) Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism. Cochrane Database of Systematic Reviews, 9, CD005258. https://doi.org/10.1002/14651858.cd005258.pub3 |
[41] | Corr, B.R., Winter, A.M., Sammel, M.D., Chu, C.S., Gage, B.F. and Hagemann, A.R. (2015) Effectiveness and Safety of Expanded Perioperative Thromboprophylaxis in Complex Gynecologic Surgery. Gynecologic Oncology, 138, 501-506. https://doi.org/10.1016/j.ygyno.2015.07.017 |
[42] | Sang, C., Zhao, N., Zhang, J., Wang, S., Guo, S., Li, S., et al. (2018) Different Combination Strategies for Prophylaxis of Venous Thromboembolism in Patients: A Prospective Multicenter Randomized Controlled Study. Scientific Reports, 8, Article No. 8277. https://doi.org/10.1038/s41598-018-25274-2 |