妇科肿瘤术后并发深静脉血栓的诊治与预防.docVIP

妇科肿瘤术后并发深静脉血栓的诊治与预防 中华妇产科杂志 1999年第8期第34卷 论著 作者：金力　沈铿　郎景和　黄惠芳　潘家琦　戴晴　王书杰 单位：金力，沈铿，郎景和，黄惠芳　中国医学科学院中国协和医科大学北京协和医院妇产科　100730；潘家琦，王书杰　血液科；戴　晴　超声科 关键词：生殖器肿瘤；女(雌)性；血栓性静脉炎；肝素 　　【摘要】　目的　探讨妇科肿瘤术后并发下肢深静脉血栓(DVT)的诊断治疗要点及预防措施。方法　回顾性分析11例妇科DVT患者和18例有DVT倾向患者的临床特点及诊断、治疗和预防的方法。结果　发生DVT的高危因素为中老年妇女、肥胖、原发病多为盆腔恶性肿瘤，特别是子宫内膜癌。辅助诊断方法以彩色多普勒血流显像为最佳。治疗采用肝素或低分子肝素如速避凝抗凝治疗，均取得较好效果。结论　中老年、肥胖的肿瘤患者，特别是恶性肿瘤患者是术后并发DVT的高危人群，手术前后应采取预防措施。抗凝治疗对DVT有较好疗效。 Diagnosis,Treatment and Prevention of Postoperative Deep Venous Thrombosis in Gynecologic Onocology JIN Li, SHEN Keng, LANG Jinghe, et al. 　　Beijing Union Hospital，Chinese Academy of Medical Sciences，Beijing Union Medical College, Beijing 100730 　　【Abstract】　Objective　To describe the clinical profile of deep venous thrombosis (DVT) after operation on pelvic tumours and to study how to choose the methods of diagnosis, treatment and prevention of DVT.Methods?The clinical characteristics,the methods of diagnosis,treatment and prevention of 11 cases with DVT and 18 cases with the tendency to DVT were analyzed retrospectively.Results　Old age, fatness and oringinal pelvic malignant tumours were the high risk factors for postoperative DVT. Especially the patients with endometrial carcinoma were with the high incidence of DVT. Colour-code Doppler ultrasonography was the best choice to diagnose DVT. Heparin or low molecule weight heparin (LMWH) anticoagulation was effective treatment in postoperative DVT.Conclusions　Old age, fatness and gynecologic malignant tumours should be considered as highrisk factors for postoperative DVT. Preoperative or postoperative prophylatic treatment of DVT should be considered in high risk population. Anticoagulation was effective in postoperative DVT. 　　【Key words】　Genital neoplasms, female　　Thrombophlebitis　　 Heparin 　　深静脉血栓(deep venous thrombosis，DVT)是外科手术常见的并发症之一。国外报道，外科手术后DVT发生率为30％～50％［1］，而在妇科恶性肿瘤或其他妇科疾病手术后的发生率为 7％～45％［2,3］。我国目前尚无确切的统计,但近年来研究发现，妇科肿瘤术后，特别是恶性肿瘤术后DVT的发生率明显增高，由于血栓脱落引起肺栓塞致使术后并发症的发生率和死亡率亦升高［4-6］。故对于妇科恶性肿瘤患者术后DVT的预防和治