在腹部和最小侵入性大样本子宫切除术后的静脉血栓塞栓症
Nguyen K Pham1, Randa J Jalloul1, Han-Yang Chen2
1Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs. Pham, Jalloul, Hui, and Leon).
Journal of minimally invasive gynecology
|July 8, 2023
概括
静脉血栓塞栓症 (VTE) 很少发生在为良性疾病进行大样本子宫切除后. 最少侵入性手术和更短的手术时间减少了VTE风险,无论子宫大小如何.
科学领域:
- 妇科外科手术 妇科外科
- 外科手术的结果
- 血栓栓塞瘤研究研究
背景情况:
- 切除子宫是一个常见的妇科手术.
- 大型样本子宫切除术带来了独特的外科手术挑战.
- 静脉血栓栓塞 (VTE) 是一个重要的术后并发症.
研究的目的:
- 为了确定在接受大样本子宫切除为良性指示的患者中VTE的发病率.
- 评估手术方法 (腹部,腹腔镜,阴道) 对静脉突发症发展的影响.
- 评估手术时间对该患者队列中静脉瘤风险的影响.
主要方法:
- 使用美国外科医生学院国家外科质量改善计划数据库 (2014-2019) 进行的回顾性队列研究.
- 包括超过122,000次为良性指示的子宫切除术,按子宫体重分层 (<100g至≥500g).
- 基于手术路线,手术持续时间和患者人口统计数据的VTE病例分析.
主要成果:
- 大样本子宫切除术 (≥500g) 的整体VTE率为0.64%.
- 在多变量调整后,在子宫体重组之间没有发现VTE几率的显著差异.
- 至少侵入性途径 (腹腔镜,阴道) 与腹腔切除相比,与较低的VTE几率相关 (aOR分别为0.62和0.46).
- 长时间的手术时间 (>120分钟) 显著增加了静脉瘤的几率 (aOR1.86).
结论:
- 在良性大样本子宫切除术后,VTE是罕见的.
- 最少侵入性的手术方法与VTE风险降低有关,即使在显著扩大的子宫的情况下也是如此.
- 在这个人群中,较长的手术时间是VTE的危险因素.
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