国际妇产科学杂志

国际妇产科学杂志 ›› 2015, Vol. 42 ›› Issue (2): 169-174.

• 论著 • 上一篇    下一篇

妇科恶性肿瘤围手术期患者深静脉血栓预防措施的系统评价

黄静，李力   

  1. 530021 南宁，广西医科大学附属肿瘤医院妇瘤科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-04-15 发布日期:2015-04-15
  • 通讯作者: 李力

The Prevention of Thromboembolism Gynecologic Cancer Patients during Perioperative：A Systematic Review

HUANG Jing，LI Li   

  1. Department of Gynecologic Oncology，Affiliated Tumor Hospital of Guangxi Medical University，Nanning 530021，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-04-15 Online:2015-04-15
  • Contact: LI Li

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摘要： 目的：系统评价妇科恶性肿瘤围手术期患者深静脉血栓形成（deep venous thromboembolism，DVT）相关预防措施的疗效和安全性。方法：计算机检索Pubmed、Cochrane Library、Medline、Embase及CNKI、重庆维普、中国生物医学文献数据库，检索时间均从建库截至2014年9月30日，同时手工检索相关的参考文献，查找国内外公开发表的关于妇科恶性肿瘤围手术期患者DVT相关预防措施的文献进行回顾分析，对符合纳入标准的随机对照试验提取资料并评价质量后，采用Stata 12.0软件进行Meta分析。结果：纳入18项随机对照研究共3 193例患者。Meta分析结果显示：①2项研究肝素组DVT的发生率较对照组低（RR=0.59，95%CI为0.36～0.96）；但是对于肺栓塞（pulmonary embolism，PE）的预防差异无统计学意义（RR=4.08，95%CI为0.71～23.53）。②3项研究表明低分子肝素组与对照组在预防DVT的发生上差异有统计学意义（RR=0.16，95%CI为0.05～0.47），仅有1项研究报道了PE，在低分子肝素组及对照组均为0例。③5项研究显示低分子肝素组与肝素组在预防DVT的发生上差异无统计学意义（RR=0.98，95%CI为0.43～2.23）；其中有4项研究显示两者对于PE的预防差异亦无统计学意义（RR=1.70，95%CI为0.44～6.63）。④2项研究对低分子肝素联合机械预防（包括弹力袜或者气压治疗）与单独使用机械预防进行比较，2种方法预防DVT的发生率差异有统计学意义（RR=0.15，95%CI为0.04～0.68）。结论：对于妇科恶性肿瘤围手术期患者采取相应的血栓预防措施是必要的，但目前治疗上仍没有统一的标准方案，需要更多高质量的全面临床随机对照试验进一步指导。

关键词: 生殖器肿瘤, 女（雌）性, 手术期间, 静脉血栓形成, 综合预防

Abstract: Objective： This study was designed to systematically analyze the world′s literature on thromboembolism prophylaxis in gynecologic oncology perioperative and evaluate the efficacy and safety of prophylaxis regimen. Methods：Computerized searches electronic databases such as Pubmed，Cochrane Library，Medline，Embase and CNKI，VIP，CBM from the date of their establishment to Sep 2014. Meta-analysis was performed on the studies meeting the criterion. Results：It included 18 randomized controlled studies and 3 193 patients. Meta analysis showed that：①The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin（RR=0.59，95%CI：0.36-0.96），but not in PE（RR=4.08，95%CI：0.71-23.53）.②LMWH-versus-control also revealed a significant decrease in DVT in patients receiving LMWH（RR=0.16，95%CI：0.05-0.47）. ③In the heparin-versus-LMWH studies，there was no significant difference（RR=0.98，95%CI：0.43-2.23）. There was no significant difference in PE in patients（RR=1.70，95%CI:0.44-6.63）. ④Combination prophylaxis can be more effectively reduce the incidence of deep vein thrombosis（RR=0.15，95%CI：0.04-0.68）. Conclusions：All gynecologic cancer patients should receive VTE prophylaxis. But no one prevention modality can be considered superior. Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.

Key words: Genital neoplasms, female, Intraoperative period, Venous thrombosis, Universal precautions