Analysis of the risk of venous thromboembolism in the perioperative period of radical cystectomy
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摘要: 目的 根治性膀胱切除术(radical cystectomy，RC)患者在手术后常常面临静脉血栓形成的风险，这不仅延长了住院时间，还可能导致严重的并发症，如肺栓塞等。本研究旨在探索真实世界中RC患者围术期静脉血栓栓塞(venous thromboembolism，VTE)事件的发生概率及其相关风险因素，为临床治疗提供指导。方法 收集2022年1月—2023年12月于天津医科大学第二医院泌尿外科行RC治疗的患者相关资料。制定相应的纳入、排除标准。通过χ2检验、logistic分析、Student t检验对统计学数据资料进行验证。结果 收集到88例患者信息，其中男72例，女16例；中位年龄71岁。围术期共确诊33例(37.5%)VTE事件，术后VTE事件26例(29.5%)，其中2例为静脉血栓进展。分析各类因素对围术期VTE的影响，发现吸烟、既往血栓栓塞病史是影响静脉血栓形成的背景风险因素(P=0.002，P=0.01)。对于术后静脉血栓来说，术前低分子肝素应用时长(P=0.01)、有无截石位操作(P=0.034)为影响其发生概率的风险因素。结论 具有血栓栓塞病史及吸烟史的患者应着重围术期血栓的预防性干预措施，在控制手术时间的同时需要进一步完善围术期预防性抗凝方案，包括但不限于围术期低分子肝素、防血栓弹力袜、下肢按摩、早期活动等措施。同时也建议行前瞻性研究进一步探索围术期静脉血栓预防性抗凝措施的效果与用药方案指导。Abstract: Objective Patients undergoing radical cystectomy (RC) are often at risk of venous thrombosis after surgery, which not only prolongs hospitalization but may also lead to serious complications, such as pulmonary embolism. The aim of this study was to explore the probability of perioperative venous thromboembolism (VTE) events and their associated risk factors in patients undergoing radical total cystectomy in the real world, and to provide guidance on clinical management.Methods Data related to patients who underwent RC in the Department of Urology at the Second Hospital of Tianjin Medical University between January 2022 and December 2023 were collected. The corresponding inclusion and exclusion criteria were established. The statistical data information was validated by χ2, logistic analysis, and Student t test.Results Information was collected on 88 patients with a median age of 71 years including 72 males and 16 females. Perioperative VTE events were diagnosed in 33 patients(37.5%) and postoperative VTE events were diagnosed in 26 patients(29.5%), of which 2 cases were progression of preoperative venous thrombosis. After analyzing the effect of various factors on perioperative VTE we found that smoking, previous history of thromboembolism were background risk factors in venous thrombosis(P=0.002, P=0.01). For postoperative venous thrombosis, the length of preoperative low molecular heparin application(P=0.01), and the presence or absence of lithotomy maneuver(P=0.034) were risk factors affecting the probability of its occurrence.Conclusion Patients with a history of thromboembolism and smoking should be focused on prophylactic interventions for perioperative thrombosis, and the perioperative prophylactic anticoagulation regimen needs to be further improved while controlling the duration of the surgery, including, but not limited to, perioperative low molecular heparin, anti-thrombotic elastic stockings, lower extremity massage, and early activity. Prospective studies are also recommended to further explore the effects of perioperative prophylactic anticoagulation on venous thrombosis and to guide the medication regimen.
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Key words:
- bladder cancer /
- radical cystectomy /
- venous thromboembolism /
- anticoagulation
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表 1 88例患者基本情况统计
例(%)，M(Q1，Q3) 项目 值 年龄/岁 71(63，76) 性别 男 72(81.8) 女 16(18.2) 吸烟史 有 40(45.4) 无 48(54.6) 饮酒史 有 29(32.9) 无 59(67.1) 高血压 有 41(46.5) 无 47(53.5) 糖尿病 有 20(22.7) 无 68(77.3) 冠心病 有 9(10.2) 无 79(89.8) 血管疾病 有 7(8.0) 无 81(92.0) 既往血栓栓塞病史 有 17(19.3) 无 71(80.7) 既往肿瘤病史 27(30.6) 膀胱癌 23(26.1) 其他肿瘤 4(4.5) 手术史 37(42.0) 腹部手术 12(13.6) 心脏手术 3(3.4) 血管手术 5(5.6) 经尿道手术 26(29.5) 
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表 2 VTE事件
例(%) 变量 术前 术后 随访 总数 VTE 9(10.2) 15(17.0) 11(12.5) 33(37.5) 其他栓塞事件 0(0) 2(2.3) 0(0) 2(2.3)
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表 3 背景因素相关性分析
例 变量 总数 VTE组
(33例)无VTE组
(55例)P值 性别 0.380 男 72 27 45 女 16 6 10 年龄 0.087 < 60 15 3 12 ≥60 73 30 43 吸烟史 0.002 有 40 15 18 无 48 18 37 饮酒史 0.682 有 29 10 19 无 59 23 36 既往血栓栓塞病史 0.010 有 17 11 6 无 71 22 49 高血压 0.544 有 41 14 27 无 47 19 28 冠心病 0.650 有 9 4 5 无 79 29 50 糖尿病 0.793 有 20 7 13 无 68 26 42 血管疾病史 0.263 有 7 4 3 无 81 29 52 肿瘤病史 0.591 有 27 9 18 无 61 24 37 既往手术史 0.956 有 37 14 23 无 51 19 32
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表 4 术后VTE相关风险因素分析
例 变量 总数 VTE组
(26例)无VTE组
(62例)P值 截石位 0.028 有 45 18 27 无 43 8 35 辅助操作 0.646 开放式 11 2 9 腔镜下 11 3 8 机器人辅助腹腔镜下 66 21 45 尿流改道 0.360 输尿管皮肤造口 15 6 9 回肠导管 60 18 42 原位新膀胱 13 2 11 术前抗凝 0.001 有 52 8 44 无 36 18 18 术前抗凝时间/h 0.006 0 36 18 18 1 25 3 22 2 19 4 15 >2 8 1 7 手术时间/ min 0.016 ≤340 23 3 20 >340~380 22 5 17 >380~438 21 7 14 >438 22 11 11
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表 5 VTE风险多因素分析
风险因素 B SE 95%CI P值 吸烟史 1.093 0.582 0.953~9.342 0.060 既往血栓栓塞病史 1.595 0.716 1.211~20.060 0.026 截石位 1.241 0.584 1.101~10.865 0.034 术前抗凝时间 -0.874 0.346 0.212~0.822 0.011 手术时间 0.007 0.004 0.999~1.014 0.073
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