卵巢癌患者术后深静脉血栓形成的Logistic回归分析
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摘要
目的:探讨卵巢癌患者术后深静脉血栓形成(DVT)的影响因素。方法:选择自2011年5月至2018年7月在孝感市中心医院接受手术治疗的卵巢癌患者282例,根据其在术后是否发生深静脉血栓形成,将其分为DVT组(即观察组)113例,非DVT组(即对照组)169例。记录两组患者的年龄、身体质量指数(BMI)、合并症、手术史、肿瘤大小、肿瘤组织学分型、淋巴结状态、平均血小板体积、血浆凝血酶原时间、D-二聚体、手术时间以及手术出血量等指标,并进行统计分析,经Logistic回归分析患者发生DVT的相关因子。结果:观察组患者其年龄、合并糖尿病、合并高血脂、合并高血压、手术史以及放疗史明显高于对照组(P<0. 05);观察组患者其肿瘤直径≥5 cm占比(77. 0%)、FIGO(Ⅲ+Ⅳ)期占比(30. 1%)、肿瘤组织(低分化+中分化)占比(88. 5%)以及淋巴结转移占比(54. 0%)明显高于对照组(P<0. 05);两组患者其血红蛋白、血浆纤维蛋白原、血浆纤维蛋白原时间、C反应蛋白以及D-二聚体差异明显(P<0. 05);两组患者其手术出血量、输血治疗以及PICC置管治疗差异明显(P<0. 05);年龄、高血压、肿瘤直径、肿瘤FIGO分期、肿瘤组织分化程度、淋巴结转移、D-二聚体过高以及PICC置管治疗是卵巢癌患者术后DVT形成的独立影响因子(P<0. 05)。结论:卵巢癌患者术后发生DVT普遍与其年龄、血脂、肿瘤组织恶化程度、D-二聚体过高等关系密切,临床上需对其加强预防、诊治,提高患者生存质量。
Objective: To explore the influencing factors for deep vein thrombosis(DVT) in ovarian cancer patients after surgery.Methods: A total of 282 ovarian cancer patients with surgery in our hospital from May 2011 to July 2018 were selected, and according to whether DVT occurring, they were divided into DVT group(n=113) and non-DVT group(control group, n=169). The age,BMI, complications, operation history, tumor size, FIGO stage, lymph node metastasis, mean platelet volume, plasma prothrombin time, D-dimer, operation time, and blood loss, etc., were recorded and analyzed, and logistic regression was used to analyze the related factors of DVT.Results: The age,diabetes mellitus, hyperlipidemia, the combining history of high blood pressure, surgery and radiation therapy in DVT group were significantly higher than in control group(P<0. 05). The proportion of tumor diameter of 5 cm or higher(77. 0%), FIGO stage(Ⅲ + Ⅳ)(30. 1%), tumor low and moderate differentiation(88. 5%), and lymph node metastasis(54. 0%) in DVT group were significantly higher than in control group(all P<0. 05). And there were significant difference in hemoglobin, blood plasma fibrinogen, plasma fibrinogen, C-reactive protein, D-dimer, surgical blood loss, transfusion therapy and PICC catheter rates between the two groups(P<0. 05). Age, hypertension, tumor diameter,FIGO staging of tumor, the degree of tumor differentiation, lymph node metastasis, D-dimer, and PICC catheter treatment were independent factors of DVT in ovarian cancer patients(P<0. 05).Conclusion: DVT in ovarian cancer patients after surgery is closely related to age, blood lipid, the degree of deterioration of tumor tissue, and high D-dimer, and early diagnosis and treatment of DVT are important to improve the quality of survival.
Objective: To explore the influencing factors for deep vein thrombosis(DVT) in ovarian cancer patients after surgery.Methods: A total of 282 ovarian cancer patients with surgery in our hospital from May 2011 to July 2018 were selected, and according to whether DVT occurring, they were divided into DVT group(n=113) and non-DVT group(control group, n=169). The age,BMI, complications, operation history, tumor size, FIGO stage, lymph node metastasis, mean platelet volume, plasma prothrombin time, D-dimer, operation time, and blood loss, etc., were recorded and analyzed, and logistic regression was used to analyze the related factors of DVT.Results: The age,diabetes mellitus, hyperlipidemia, the combining history of high blood pressure, surgery and radiation therapy in DVT group were significantly higher than in control group(P<0. 05). The proportion of tumor diameter of 5 cm or higher(77. 0%), FIGO stage(Ⅲ + Ⅳ)(30. 1%), tumor low and moderate differentiation(88. 5%), and lymph node metastasis(54. 0%) in DVT group were significantly higher than in control group(all P<0. 05). And there were significant difference in hemoglobin, blood plasma fibrinogen, plasma fibrinogen, C-reactive protein, D-dimer, surgical blood loss, transfusion therapy and PICC catheter rates between the two groups(P<0. 05). Age, hypertension, tumor diameter,FIGO staging of tumor, the degree of tumor differentiation, lymph node metastasis, D-dimer, and PICC catheter treatment were independent factors of DVT in ovarian cancer patients(P<0. 05).Conclusion: DVT in ovarian cancer patients after surgery is closely related to age, blood lipid, the degree of deterioration of tumor tissue, and high D-dimer, and early diagnosis and treatment of DVT are important to improve the quality of survival.
引文
[1]张爽爽,夏庆民,郑荣寿,等.中国2010年卵巢癌发病与死亡分析[J].中国肿瘤,2016,25(3):169-173.Zhang SS, Xia QM, Zheng RS, et al. Analysis of ovarian cancer incidence and death in China in 2010[J]. China Tumor, 2016,25(3):169-173.
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[4]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第2版)[J].中华外科学杂志,2012,50(7):611-614.Group of Vascular Surgery, Society of Surgery, Chinese Medical Association. Diagnostic and therapeutic guidelines for deep venous thrombosis(2nd edition)[J].Chinese Journal of Surgery, 2012,50(7):611-614.
[5]马芳,钱梅梅,袁长翮.下肢深静脉血栓的彩色多普勒超声诊断[J].中华全科医学,2011,9(4):639,641.Ma F, Qian MM, Yuan CH. Color doppler ultrasound diagnosis of deep venous thrombosis of lower extremity[J]. Chinese General Medicine, 2011,9(4):639,641.
[6] Tamura K, Nakahara H. MR venography for the assessment of deep vein thrombosis in lower extremities with varicose veins[J]. Ann Vasc Dis, 2014, 7(4):399-403.
[7]姚丽丽,郝粉娥,郭佑民. CT肺血管成像诊断肺栓塞的研究进展[J].实用放射学杂志,2018,34(1):136-138.Yao LL, He FE,Guo YM. Advances in the diagnosis of pulmonary embolism by CT angiography[J]. Journal of Practical Radiology, 2018,34(1):136-138.
[8] Serour GI. A vision for FIGO 2009-2012[J]. Int J Gynaecol Obstet, 2010,108(2):93-96.
[9]付霞霏,何援利,刘木彪,等.开腹卵巢癌肿瘤细胞减灭术中应用腹腔镜器械与传统手术的对照研究[J].实用医学杂志,2014,30(15):2 450-2 452.Fu XF, He YL, Liu MB, et al. A comparative study of laparoscopic and conventional surgery in the treatment of ovarian cancer cells[J]. Journal of Practical Medicine, 2014,30(15):2 450-2 452.
[10]蒲纯,许小毛,乔力松,等.恶性肿瘤并发静脉血栓栓塞症的临床分析[J].中华老年多器官疾病杂志, 2016,15(11):810-814.Pu C, Xu XM, Qiao LS, et al. Clinical analysis of cancer patients with venous thromboembolism[J]. Chin J Mult Organ Dis Elderly, 2016,15(11):810-814.
[11]李惠霞,肖珊.恶性肿瘤患者术后深静脉血栓危险因素及预防措施的研究进展[J].护士进修杂志,2017, 32(11):1 008-1 010.Li HX, Xiao S. Research progress on risk factors and preventive measures of deep vein thrombosis in patients with malignant tumor after operation[J]. Journal of Nurse Training, 2017,32(11):1 008-1 010.
[12] Douma RA, Tan M, Schutgens REG, et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded[J]. Haematologica, 2012, 97(11):1 507-1 513.
[13] Schulz C, Engelmann B, Massberg S. Crossroads of coagulation and innate immunity:the case of deep vein thrombosis[J]. J Thromb Haemost, 2013, 11(Suppl1):233-241.
[14] Li Z, Liu L, Wang Y, et al. Factors impact the adherence rate of prophylaxis for deep venous thrombosis in acute ischaemic stroke patients:an analysis of the China National Stroke Registry[J]. Neurol Res, 2015,37(5):427-433.
[15]成莉,李琳,邢辉.首次肿瘤细胞减灭术与新辅助化疗后间隔性肿瘤细胞减灭术治疗Ⅲ和Ⅳ期卵巢癌患者后其对铂类药物耐药性及生存期的影响[J].中国全科医学, 2014,17(9):1 021-1 025.Cheng L, Li L, Xing H. Tumor cells to destroy the loss and for the first time interval after neoadjuvant chemotherapy for the treatment of tumor cells removeⅢandⅣstage ovarian cancer patients after its impact on platinum drug resistance and survival[J]. Chinese General Medicine, 2014,17(9):1 021-1 025.
[16]谭细凤,李怀芳,谷雨枫.新辅助化疗联合肿瘤细胞减灭术治疗晚期上皮性卵巢癌的随访观察[J].实用妇产科杂志, 2017,33(1):62-65.Tan XF,Li HF,Gu YF. Follow-up observatlon of neoadjuvant chemotherapy combined with tumor cell reduction in the treatment of advanced epithelial ovarian cancer[J]. Jurnal of Practical Obstetrics and Gynecology,2017,33(1):62-65.
[2]王刚,王卫.腹腔镜在卵巢癌手术分期与治疗中的应用[J].中国实用妇科与产科杂志,2012,28(3):187-190.Wang G,Wang W. Application of laparoscopy in staging and treatment of ovarian cancer[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2012,28(3):187-190.
[3]张晓然,王伟宁,郭瑞臣.卵巢癌并发下肢深静脉血栓形成药物治疗实践[J].中国现代药物应用,2014,8(7):180-181.Zhang XR, Wang WN, Guo RC. Drug therapy for ovarian cancer complicated with lower extremity deep venous thrombosis[J]. Application of Modern Chinese Medicine, 2014,8(7):180-181.
[4]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第2版)[J].中华外科学杂志,2012,50(7):611-614.Group of Vascular Surgery, Society of Surgery, Chinese Medical Association. Diagnostic and therapeutic guidelines for deep venous thrombosis(2nd edition)[J].Chinese Journal of Surgery, 2012,50(7):611-614.
[5]马芳,钱梅梅,袁长翮.下肢深静脉血栓的彩色多普勒超声诊断[J].中华全科医学,2011,9(4):639,641.Ma F, Qian MM, Yuan CH. Color doppler ultrasound diagnosis of deep venous thrombosis of lower extremity[J]. Chinese General Medicine, 2011,9(4):639,641.
[6] Tamura K, Nakahara H. MR venography for the assessment of deep vein thrombosis in lower extremities with varicose veins[J]. Ann Vasc Dis, 2014, 7(4):399-403.
[7]姚丽丽,郝粉娥,郭佑民. CT肺血管成像诊断肺栓塞的研究进展[J].实用放射学杂志,2018,34(1):136-138.Yao LL, He FE,Guo YM. Advances in the diagnosis of pulmonary embolism by CT angiography[J]. Journal of Practical Radiology, 2018,34(1):136-138.
[8] Serour GI. A vision for FIGO 2009-2012[J]. Int J Gynaecol Obstet, 2010,108(2):93-96.
[9]付霞霏,何援利,刘木彪,等.开腹卵巢癌肿瘤细胞减灭术中应用腹腔镜器械与传统手术的对照研究[J].实用医学杂志,2014,30(15):2 450-2 452.Fu XF, He YL, Liu MB, et al. A comparative study of laparoscopic and conventional surgery in the treatment of ovarian cancer cells[J]. Journal of Practical Medicine, 2014,30(15):2 450-2 452.
[10]蒲纯,许小毛,乔力松,等.恶性肿瘤并发静脉血栓栓塞症的临床分析[J].中华老年多器官疾病杂志, 2016,15(11):810-814.Pu C, Xu XM, Qiao LS, et al. Clinical analysis of cancer patients with venous thromboembolism[J]. Chin J Mult Organ Dis Elderly, 2016,15(11):810-814.
[11]李惠霞,肖珊.恶性肿瘤患者术后深静脉血栓危险因素及预防措施的研究进展[J].护士进修杂志,2017, 32(11):1 008-1 010.Li HX, Xiao S. Research progress on risk factors and preventive measures of deep vein thrombosis in patients with malignant tumor after operation[J]. Journal of Nurse Training, 2017,32(11):1 008-1 010.
[12] Douma RA, Tan M, Schutgens REG, et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded[J]. Haematologica, 2012, 97(11):1 507-1 513.
[13] Schulz C, Engelmann B, Massberg S. Crossroads of coagulation and innate immunity:the case of deep vein thrombosis[J]. J Thromb Haemost, 2013, 11(Suppl1):233-241.
[14] Li Z, Liu L, Wang Y, et al. Factors impact the adherence rate of prophylaxis for deep venous thrombosis in acute ischaemic stroke patients:an analysis of the China National Stroke Registry[J]. Neurol Res, 2015,37(5):427-433.
[15]成莉,李琳,邢辉.首次肿瘤细胞减灭术与新辅助化疗后间隔性肿瘤细胞减灭术治疗Ⅲ和Ⅳ期卵巢癌患者后其对铂类药物耐药性及生存期的影响[J].中国全科医学, 2014,17(9):1 021-1 025.Cheng L, Li L, Xing H. Tumor cells to destroy the loss and for the first time interval after neoadjuvant chemotherapy for the treatment of tumor cells removeⅢandⅣstage ovarian cancer patients after its impact on platinum drug resistance and survival[J]. Chinese General Medicine, 2014,17(9):1 021-1 025.
[16]谭细凤,李怀芳,谷雨枫.新辅助化疗联合肿瘤细胞减灭术治疗晚期上皮性卵巢癌的随访观察[J].实用妇产科杂志, 2017,33(1):62-65.Tan XF,Li HF,Gu YF. Follow-up observatlon of neoadjuvant chemotherapy combined with tumor cell reduction in the treatment of advanced epithelial ovarian cancer[J]. Jurnal of Practical Obstetrics and Gynecology,2017,33(1):62-65.