中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (02): 178-183.DOI: 10.19538/j.cjps.issn1005-2208.2023.02.11

• 论著 • 上一篇    下一篇

胃肠恶性肿瘤病人行腹腔镜术后发生肺动脉栓塞的临床特征及危险因素分析

沈    乾，毛    淦，吕剑波，曾利武，杜雨强，蒋    祈，王    征，高金波，张    鹏，陶凯雄   

  1. 华中科技大学同济医学院附属协和医院胃肠外科，湖北武汉430022
  • 出版日期:2023-02-01 发布日期:2023-02-20

  • Online:2023-02-01 Published:2023-02-20

摘要： 目的    分析胃肠恶性肿瘤病人行腹腔镜术后发生肺动脉栓塞（PE）的临床特征及危险因素，构建风险预测模型并评估其临床预测价值，为早期防治PE提供参考。 方法    回顾性收集华中科技大学同济医学院附属协和医院2019年1月至2022年3月间行腹腔镜手术的胃肠恶性肿瘤病人临床资料，将术后发生PE病人作为研究组（PE组，46例），按1∶3的比例随机个体匹配同期未发生PE病人作为对照组（非PE组，138例）。 结果    PE组中PE确诊时间为术后（6±3）d，临床症状主要包括胸闷、呼吸困难（30例，65.2%）、血氧饱和度下降（14例，30.4%）和胸痛（11例，23.9%）。临床体征主要包括呼吸急促（31例，67.4%）（＞25次/min），心动过速（22例，47.8%）
（＞100次/min）。PE组术后总住院时间为（16±6）d，确诊PE至出院时间为（10±4）d，无术后30 d内死亡病人。单因素分析结果显示年龄≥60岁、冠心病、下肢DVT和手术时间≥3 h是胃肠恶性肿瘤病人行腹腔镜术后发生PE的相关危险因素（P<0.05）。多因素分析结果显示年龄≥60岁、手术时间≥3 h和下肢DVT是影响胃肠恶性肿瘤病人行腹腔镜术后发生PE的独立危险因素（P<0.05）；基于上述3个独立危险因素构建风险预测模型并绘制受试者工作特征（ROC）曲线，年龄、手术时间、下肢深静脉血栓形成（DVT）及列线图的曲线下面积（AUC）分别为0.641，0.649，0.717，0.795。 结论    胃肠恶性肿瘤病人行腹腔镜术后PE症状多以胸闷呼吸困难、血氧饱和度下降和胸痛为主；年龄≥60岁、手术时间≥3 h及合并下肢DVT是胃肠恶性肿瘤病人行腹腔镜术后发生PE的独立危险因素；基于上述独立危险因素构建的风险预测模型具有较好的临床预测价值。

关键词: 肺栓塞, 胃肠恶性肿瘤, 腹腔镜手术, 危险因素, 列线图

Abstract: Clinical characteristics and risk factors of pulmonary embolism after laparoscopic surgery in patients with gastrointestinal malignancies        SHEN Qian, MAO Gan, LV Jian-bo, et al. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Corresponding authors: TAO Kai-xiong, E-mail: kaixiongtao@hust.edu.cn; ZHANG Peng, E-mail: zhangpengwh@hust.edu.cn
Abstract    Objective     To analyze the clinical characteristics and risk factors of pulmonary embolism (PE) in patients with gastrointestinal malignant tumor after laparoscopic surgery, we build a risk prediction model and evaluate its clinical predictive value to  provide a reference for early prevention and treatment of PE. Methods    The PE patients of gastrointestinal malignant tumors after laparoscopic surgery in Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2019 to March 2022 were retrospectively collected as the study group (PE group,46 cases); The control group (non-PE group,138 cases) was randomly selected at a ratio of 1∶3 to collect patients with gastrointestinal malignant tumors who did not have PE after laparoscopic surgery at the same time. Results In the PE group, the diagnosis time of PE was (6 ±3) days after the operation. The clinical symptoms mainly included chest tightness and dyspnea (30 cases, 65.2%), decreased blood oxygen saturation (14 cases, 30.4%) ，and chest pain (11 cases, 23.9%). The clinical signs mainly included tachypnea (31 cases, 67.4%) (>25 times/minute) and tachycardia (22 cases, 47.8%) (>100 times/minute). In PE group, the total hospital stay was (16±6) days, the time from diagnosis of PE to discharge was (10± 4) days, and there was no death within 30 days after the operation. Univariate analysis showed that age ≥ 60 years, coronary heart disease, lower extremity DVT and operation duration ≥ 3h were the related risk factors for PE in patients with gastrointestinal malignant tumor after laparoscopic surgery (P<0.05). Multivariate analysis showed that age ≥ 60 years, operation duration ≥ 3h and DVT of lower limbs were independent risk factors for PE in patients with gastrointestinal malignant tumor after laparoscopic surgery (P<0.05); based on the above three independent risk factors, the risk prediction model was constructed and the ROC curve was drawn. The area under the curve (AUC) of age, operation duration, lower limb DVT and nomogram were respectively 0.641, 0.649, 0.717 and 0.795. Conclusion    The main symptoms of PE in patients with gastrointestinal malignant tumor after laparoscopic surgery are chest tightness, dyspnea, decreased blood oxygen saturation and chest pain; age ≥ 60 years old, operation duration ≥ 3h and DVT of lower limbs are independent risk factors， for PE in patients with gastrointestinal malignant tumor after laparoscopic surgery; the risk prediction model based on the above independent risk factors has good clinical prediction value for such patients.

Key words: pulmonary embolism, gastrointestinal malignancies, laparoscopic surgery, risk factor, nomogram