妇科恶性肿瘤患者术后深静脉血栓危险因素的Meta分析
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作者单位:

1.广西医科大学肿瘤医学院,广西 南宁 530021;2.广西医科大学附属肿瘤医院 消化肿瘤内科,广西 南宁 530021

作者简介:

张玲,广西医科大学肿瘤医学院硕士研究生,主要从事妇科肿瘤围手术期管理方面的研究。

基金项目:

广西壮族自治区卫生健康委员会自筹经费科研基金资助项目(Z20190816);广西壮族自治区中医药管理局自筹经费科研基金资助项目(GXZYZ20210428)。


Meta-analysis of risk factors for postoperative deep vein thrombosis in gynecological cancer patients
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Affiliation:

1.College of Oncology, Guangxi Medical University, Nanning 530021, China;2.Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, China

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    摘要:

    背景与目的 妇科恶性肿瘤患者术后发生深静脉血栓(DVT),可引起患者肺栓塞或猝死,严重威胁患者的生命,本研究通过Meta分析明确妇科恶性肿瘤患者术后发生DVT的危险因素,为预防和降低妇科恶性肿瘤患者术后DVT的发生提供循证依据。方法 计算机检索多个国内外数据库,搜集有关妇科恶性肿瘤患者术后DVT危险因素的队列研究或病例对照研究,检索时限均为建库至2021年3月,采用Revman 5.3软件进行Meta分析。结果 共纳入19篇文献,包含4 964例患者,其中病例组1 040例,对照组3 924例,共研究了36项危险因素。将其中10项危险因素进行了数据合并分析显示,既往有DVT史(OR=3.70,95% CI=2.15~6.35,P<0.001)、年龄大(OR=2.99,95% CI=1.85~4.82,P<0.001)、合并高血压(OR=2.25,95% CI=1.32~3.83,P=0.003)、手术时间长(OR=1.03,95% CI=1.02~1.04,P<0.001)、BMI增加(OR=1.87,95% CI=1.55~2.25,P<0.001)、术后卧床时间长(OR=3.17,95% CI=2.56~3.92,P<0.001)、纤维蛋白原高(OR=2.80,95% CI=2.26~3.47,P<0.001)、肿瘤分期晚(OR=2.56,95% CI=1.83~3.57,P<0.001)、发生淋巴结转移(OR=2.88,95% CI=1.58~5.25,P=0.000 6)、D-二聚体高(OR=2.52,95% CI=1.84~3.43,P<0.001)均为妇科恶性肿瘤患者术后发生危险因素。结论 临床医护人员应结合本研究结果所确定10项危险因素,积极识别术后易发生DVT的妇科恶性肿瘤高危人群,并提供针对性的措施预防或降低其术后发生DVT风险。

    Abstract:

    Background and Aims Deep vein thrombosis (DVT) in patients after surgery for gynecological cancer will cause pulmonary embolism or sudden death, and poses a serious threat to patient's life. This study was conducted to identify risk factors for postoperative DVT in patients with gynecologic cancer through a Meta-analysis, so as to provide an evidence-based basis for preventing and reducing the occurrence of postoperative DVT in gynecologic cancer patients.Methods The cohort studies or case-control studies concerning risk factors for postoperative DVT in gynecological cancer patients were collected by online search in several national and international databases. The retrieval time was from inception of the database to March 2021. Meta-analysis was conducted by Revman 5.3 software.Results A total of 19 studies were included involving 4 964 patients, with 1 040 patients in the case group and 3 924 patients in control group, in which a total of 36 risk factors were studied. Results of analysis of the pooled data for 10 risk factors showed that previous history of DVT (OR=3.70, 95% CI=2.15-6.35, P<0.001), old age (OR=2.99, 95% CI=1.85-4.82, P<0.001), concomitant hypertension (OR=2.25, 95% CI=1.32-3.83, P=0.003), prolonged operative time (OR=1.03, 95% CI=1.02-1.04, P<0.001), increased BMI (OR=1.87, 95% CI=1.55-2.25, P<0.001), longer postoperative stay in bed (OR=3.17, 95% CI=2.56-3.92, P<0.001), high fibrinogen level (OR=2.80, 95% CI=2.26-3.47, P<0.001), advanced tumor stage (OR=2.56, 95% CI=1.83-3.57, P<0.001), presence of lymph node metastasis (OR=2.88, 95% CI=1.58-5.25, P=0.000 6), and high D-dimer level (OR=2.52, 95% CI=1.84-3.43, P<0.001) were all risk factors for postoperative DVT in gynecologic cancer patients.Conclusion Based on the 10 risk factors identified in this study, the clinicians should aggressively identify the high-risk population for postoperative DVT among gynecologic cancer patients, and then provide specific measures to prevent or reduce the risk of DVT for them.

    图1 文献检索流程及结果Fig.1 Literature screening process and results
    图2 既往DVT史与妇科恶性肿瘤患者术后DVT关系的森林图Fig.2 Forest plot of relationship between previous history of DVT and postoperative DVT in gynecological cancer patients
    图3 年龄与妇科恶性肿瘤患者术后DVT关系的森林图Fig.3 Forest plot of relationship between age and postoperative DVT in gynecological cancer patients
    图4 高血压与妇科恶性肿瘤患者术后DVT关系的森林图Fig.4 Forest plot of relationship between hypertension and postoperative DVT in gynecological cancer patients
    图5 手术时间与妇科恶性肿瘤患者术后DVT关系的森林图Fig.5 Forest plot of relationship between operative time and postoperative DVT in gynecological cancer patients
    图6 BMI与妇科恶性肿瘤患者术后DVT关系的森林图Fig.6 Forest plot of relationship BMI and postoperative DVT in gynecological cancer patients
    图7 术后卧床时间与妇科恶性肿瘤患者术后DVT关系的森林图Fig.7 Forest plot of relationship between length of postoperative stay in bed and postoperative DVT in gynecological cancer patients
    图8 术后纤维蛋白原与妇科恶性肿瘤患者术后DVT关系的森林图Fig.8 Forest plot of relationship between postoperative fibrinogen level and postoperative DVT in gynecological cancer patients
    图9 肿瘤分期与妇科恶性肿瘤患者术后DVT关系的森林图Fig.9 Forest plot of relationship between tumor stage and postoperative DVT in gynecological cancer patients
    图10 淋巴结转移与妇科恶性肿瘤患者术后DVT关系的森林图Fig.10 Forest plot of relationship between lymph node metastasis and postoperative DVT in gynecological cancer patients
    图11 D-二聚体与妇科恶性肿瘤患者术后DVT关系的森林图Fig.11 Forest plot of relationship between D-dimer and postoperative DVT in gynecological cancer patients
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张玲,江锦芳,周帅,刘凌,张寒琼,蒋婷,黄思明.妇科恶性肿瘤患者术后深静脉血栓危险因素的Meta分析[J].中国普通外科杂志,2021,30(12):1441-1452.
DOI:10.7659/j. issn.1005-6947.2021.12.008

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  • 收稿日期:2021-08-04
  • 最后修改日期:2021-11-18
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  • 在线发布日期: 2022-01-07