标题：食管癌根治术患者术后发生下肢深静脉血栓的危险因素及血栓风险评估

      作者：鱼芳 1，樊成涛 2，白冰 1，武愫斌 1    商洛市中心医院肿瘤内科 1、胸外科 2，陕西 商洛 726000

      卷次： 2023年34卷9期

      【摘要】目的 评估食管癌根治术患者术后的血栓风险，探究患者术后发生下肢深静脉血栓(DVT)的危险因素。方法 回顾性分析2020年1月至2021年1月在商洛市中心医院接受食管癌根治术治疗的156例食管癌患者的临床资料，根据DVT发生情况分为DVT组(n=38)和非DVT组(n=118)，对患者术后发生DVT的相关因素进行单因素分析，再采用多因素Logistic回归分析确定DVT发生的独立危险因素。结果 单因素分析结果显示，DVT组患者的年龄大于非DVT组[(67.94±8.48)岁 vs (64.25±7.62)岁]，差异有统计学意义(P<0.05)，合并糖尿病、心血管疾病、骨折、呼吸道疾病、肝肾疾病、凝血因子功能亢进患者的比例明显高于非DVT组(36.84% vs 20.34%、31.58% vs 15.25%、26.32%vs 12.71%、28.95% vs 10.17%、21.05% vs 8.47%、52.63% vs 26.27%)，术中出血量、术后卧床时间、D-二聚体水平明显多(长)于非DVT组[(62.63±12.46) mL vs (57.68±10.42) mL、(32.71±5.48) d vs (28.63±4.72) d、(6.76±1.04) mg/L vs (2.18±0.65) mg/L]，差异均有统计学意义(P<0.05)；DVT组患者的 Caprini评分为(6.48±2.01)分，明显高于非DVT组的(3.57±1.14)分，差异有统计学意义(P<0.05)，DVT组患者的血栓风险高危险度和极高危险度的总比例为92.10%，明显高于非DVT组的73.73%，差异有统计学意义(P<0.05)；经多因素Logistic回归分析结果显示，年龄、合并呼吸道疾病、肝肾疾病、术后卧床时间、D-二聚体水平和凝血因子功能亢进均是影响食管癌根治术患者术后发生DVT的独立危险因素(P<0.05)。结论 Caprini血栓风险模型能够有效预测食管癌根治术后DVT发生的风险，年龄、呼吸道疾病、肝肾疾病、术后卧床、D-二聚体和凝血因子功能亢进是影响食管癌根治术患者发生DVT的危险因素。
      【关键词】食管癌根治术；下肢深静脉血栓；危险因素；风险评估
      【中图分类号】 R735.1 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1259—04

Risk factors of lower extremity deep venous thrombosis and thrombosis risk assessment after radical surgery foresophageal carcinoma.
YU Fang 1, FAN Cheng-tao 2, BAI Bing 1, WU Su-bin 1. Department of Oncology 1, Department ofThoracic Surgery 2, Shangluo Central Hospital, Shangluo 726000, Shaanxi, CHINA
【Abstract】 Objective To evaluate the thrombosis risk after radical surgery for esophageal carcinoma, and in-vestigate the risk factors for lower extremity deep venous thrombosis (DVT) after surgery. Methods This study retro-spectively analyzed the clinical data of 156 patients who underwent radical surgery for esophageal carcinoma in Shan-gluo Central Hospital between January 2020 and January 2021. The patients were divided into DVT group (n=38) andnon-DVT group (n=118) according to the presence or absence of DVT. Univariate analysis and multivariate logistic re-gression analysis were performed to screen the independent risk factors for DVT. Results Univariate analysis resultsshowed that patients in the DVT group were significantly older than those in the non-DVT group: (67.94±8.48) years oldvs (64.25±7.62) years old, P<0.05. The proportions of patients with diabetes, cardiovascular disease, fracture, respiratorydisease, liver and kidney disease, and hyperfunction of coagulation factors were significantly higher than those in thenon-DVT group (P<0.05): 36.84% vs 20.34%, 31.58% vs 15.25%, 26.32% vs 12.71%, 28.95% vs 10.17%, 21.05% vs8.47%, 52.63% vs 26.27%. The intraoperative blood loss, postoperative time in bed, and D-dimer level were more, lon-ger or higher than those of the non-DVT group (P<0.05): (62.63±12.46) mL vs (57.68±10.42) mL, (32.71±5.48) d vs(28.63±4.72) d, (6.76±1.04) mg/L vs (2.18±0.65) mg/L. The Caprini score of the DVT group was significantly higherthan that of the non-DVT group: (6.48±2.01) vs (3.57±1.14), P<0.05. The proportion of high risk and extremely high riskof thrombosis in DVT group was significantly higher than that in non-DVT group (92.10% vs 73.73%, P<0.05). Multivar-iate logistic regression analysis showed that age, respiratory disease, liver and kidney disease, postoperative time in bed,D-dimer level, and hyperfunction of coagulation factors were independent risk factors for DVT after radical surgery foresophageal carcinoma (P<0.05). Conclusion The Caprini thrombosis risk model can effectively help to predict the riskof DVT after radical surgery for esophageal carcinoma. Age, respiratory disease, liver and kidney disease, postoperativerest in bed, D-dimer, and hyperfunction of coagulation factors are risk factors for DVT after radical surgery for esopha-geal carcinoma.
      【Key words】 Radical surgery for esophageal carcinoma; Lower extremity deep venous thrombosis; Risk factor;Risk assessment