| BackgroundPulmonary embolism(PE)is a clinical and pathophysiological syndrome,in which an endogenous or exogenous embolus from the systemic venous system or the right side of the heart blocks the pulmonary artery or branches and causes pulmonary circulation and respiratory dysfunction.Embolus of PE includes thrombus,fat,amniotic fluid,air,tumor embolus and infective embolus,among which 99%embolus of PE is thrombus,so it is also called pulmonary thromboembolism(PTE).The female pelvic vein is dense,and the uterine vein plexus is connected with the rectum and bladder vein plexus.The body is in anaesthesia,braking,dehydration and estrogen and other factors under the action of the whole perioperative period in the state of hypercoagulation.Special surgical postures(Trendelenburg)increase the risk of deep venous thrombosis(DVT)formation and shedding.Therefore,gynecological surgery patients are in addition to orthopedic surgery patients and another prone to PE high-risk groups.PE clinical symptoms are not typical,rapid onset,rapid progress,high rate of missed diagnosis and misdiagnosis.It's one of the important causes of sudden death after gynecological surgery patients.Mastering the risk factors of pulmonary embolism and taking preventive measures for the high-risk population are the key measures to reduce the incidence of pulmonary embolism.Early diagnosis and timely treatment can significantly reduce the mortality of patients and improve the prognosis of patients undergoing gynecological surgery.ObjectiveThe purpose of this study was to explore the clinical characteristics and risk factors of pulmonary embolism after gynecological pelvic surgery,improving clinicians' awareness of perioperative prevention and treatment of pulmonary embolism,identify high-risk groups and give early intervention measures,so as to reduce the incidence of pulmonary embolism and improve the prognosis of surgical patients.Materials and MethodsA case-control study was conducted,A total of 22 patients with pulmonary embolism who were admitted to the first affiliated hospital of Zhengzhou university from May 2000 to October 2019 for surgical treatment and complicated pulmonary embolism were selected as the case group.A total of 88 patients without venous thromboembolism who underwent gynecological surgery during the same period were randomly selected as the control group(the ratio of case group to control group was 1:4).To collect general and clinical data of patients in the two groups,including age,height and weight,disease type,Combined diseases,smoking history,Combined oral contraceptives(COCs),operation method,operation time,intraoperative blood loss and perioperative blood transfusion.Patients with pulmonary embolism also need to collect clinical signs and symptoms,laboratory and imaging findings,preventive measures for perioperative thrombus,treatment measure,and outcomes.SPSS22.0 was used for statistical analysis of the data,counting data is expressed as a percentage(%),comparison between groups was conducted by ?2 test,continuous corrected ?2 test or Fisher exact probability test;the measurement data of normal distribution are expressed by the median±standard deviation(x±s),t test and correction t test were used for intergroup comparison.First,univariate regression analysis was performed on the variables that may be related to the occurrence of pulmonary embolism.Variables with P<0.05 entered the binary logistic regression analysis.When P value<0.05,the difference was considered statistically significant.Result1.A total of 22 patients with PTE after gynecological surgery in our hospital were included,with an average age of 50.5±11.9 years and a body mass index(BMI)?25 kg/m2 in 8 cases,with an average BMI of 23.6±1.2 kg/m2.There were 15 cases with malignant tumors(5 cases of cervical cancer,5 cases of ovarian cancer and 5 cases of endometrial cancer),and other benign gynecological diseases including:1 case of precancerous lesions of cervical cancer(4.5%),2 cases of pelvic organ prolapse(9.0%),1 case of pregnancy-related diseases(4.5%),3 cases of uterine fibroids and adenomyosis(13.6%).There were 9 cases with complications(7 cases with hypertension,2 cases with hypertension and diabetes).There were 1 cases of open surgery(4.5%)and 21 cases of laparoscopic surgery(95.5%).2.A total of 88 patients with non-venous thromboembolism after gynecological surgery in our hospital were included,with an average age of 41.9±12.2 years old and a BMI of?25 kg/m2 in 9 cases,with an average BMI of 22.7±1.2 kg/m2.22 cases with malignant tumor(9 cases of cervical cancer,ovarian cancer 7 cases,6 cases of endometrial carcinoma),other benign disease of department of gynaecology include:cervical cancer lesion before 5 cases(5.7%),16 cases of ovarian benign tumor(18.2%),7 cases of pelvic inflammatory disease(8.0%),pelvic organ prolapse,3 cases(3.4%),6 cases with pregnancy related diseases(6.8%),uterine myoma and uterine adenomyosis,29 cases(33.0%).There were 12 cases of complications(8 cases of hypertension,4 cases of diabetes).There were 3 cases of open surgery(3.4%)and 85 cases of laparoscopic surgery(96.6%).3.Of the 22 patients with pulmonary embolism,12(54.5%)occurred within 3 days after surgery.13(59.1%)of the 22 patients with pulmonary embolism felt dyspnea.Other symptoms included chest pain in 10(45.5%),palpitations in 5(22.7%),cough in 4(18.2%),syncope in 2(9.1%),shock in 3(13.6%),and hemoptysis in 1(4.5%).18(81.8%)of the 22 patients with pulmonary embolism presented with shortness of breath.Other signs included 8 cases of tachycardia(36.4%),5 cases of cyanosis(22.7%),4 cases of pulmonary reflexes(18.2%),3 cases of fever(13.6%),3 cases of wheezzles(13.6%),3 cases of hypotension(13.6%),2 cases of hyperactive pulmonary secondary heart sounds(9.1%),1 case of pleural friction sounds(4.5%),and 1 case of pleural effusion(4.5%).The main laboratory findings were hypoxemia(17/22,90.9%)and elevation of d-dimer(22/22,100%).4.Of the 22 patients with pulmonary embolism,12(54.5%)underwent preoperative VTE risk assessment,and the risk assessment was medium to high risk.13 cases(59.1%)were treated with thromboprophylaxis during the perioperative period.Which treated with intermittent pneumatic compression(IPC)and application of Low molecular heparin(Low molecular weight heparin,LMWH),7 cases(31.8%),single application of LMWH in 5 patients(22.7%),single application IPC1 cases(4.5%).In the end,6 cases(27.3%)died,among which 2 cases died directly,4 cases gave up rescue,and 16 cases were discharged for anticoagulant treatment.The case fatality rate(2/13,15.4%)of patients with pulmonary embolism who took thrombopreventive measures during the perioperative period was lower than that of patients with pulmonary embolism who did not take thrombopreventive measures(4/9,44.4%).5.The two groups of patient's age,body mass index,disease nature,merge disease,smoking history,oral history of female progestational hormone,operation modes,operation time,intraoperative blood loss,perioperative blood transfusion and so on 10 May factors associated with pulmonary embolism were analyzed,and found that the age(P<0.001),body mass index(P=0.002),malignant tumor(P<0.001),high blood pressure(P=0.001),surgery(P=0.021),the bleeding time(P=0.001)associated with pulmonary embolism occurs.6.Binary logistic regression analysis showed that increased body mass index(OR=1.845,P=0.045,95%CI:1.013?3.360),increased intraoperative blood loss(OR=1.018,P=0.004,95%CI:1.006?1.030),and hypertension(OR=4.937,P=0.025,95%CI:1.228?19.851)were independent risk factors for pulmonary embolism.Conclusion1.Gynecological perioperative pulmonary embolism is characterized by acute onset,rapid progression,atypical clinical symptoms and high mortality.2.Increased body mass index,increased intraoperative blood loss,and hypertension were independent risk factors for pulmonary embolism after gynecological surgery.Gynecologists should pay attention to the risk assessment of VTE and take standard preventive measures for high-risk groups with risk factors. |
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