| Objective:Previous retrospective studies have shown that the incidence of VTE after surgery in patients with esophageal and esophagogastric cancer is approximately 2-7%,but prospective studies in recent years have suggested that this figure may be underestimated.The purpose of this study was to investigate the incidence and characteristics of Venous Thromboembolism,VTE in patients with esophageal cancer and esophagogastric junction cancer after surgery,and to verify the value of Caprini Thromboembolism risk assessment scale(2010 version,2013version and improved version)in predicting postoperative Venous Thromboembolism events in patients.Methods:a prospective observational study was conducted to collect the clinical data of 86 patients with esophageal cancer and esophagogastric junction cancer treated by thoracic surgery in the east hospital of the fourth hospital of hebei medical university from July,2019to February,2020.(Age range:46-81;Types of cancer:54 cases of esophageal cancer,32 cases of esophagogastric junction cancer;Types of operation:29 cases of left thoracotomy and 22 cases of total endoscopy with esophageal cancer;25 cases of left thoracotomy and 6 cases of open abdomen with esophagogastric junction cancer).Preoperative color doppler ultrasound and plasma d-2 polymer examination were performed on all the patients,and those with blood thrombus detected by color doppler ultrasound were excluded from the group.All patients were assessed before surgery using the Caprini Risk assessment model(Caprini RAM)2010,2013 and improved versions.All patients were evaluated again after surgery,and a routine subcutaneous injection of da heparin sodium 5000 units per day was administered to the abdominal wall to prevent thrombosis.The plasma d-2 polymer was examined on day 1,3,5 and 7 after the operation,and color doppler ultrasound was performed on day 1 and 7 after the operation.Color doppler ultrasound indicated that patients with thrombus were treated with a subcutaneous injection of da heparin sodium injection of 5000 units 2/day in the abdominal wall,and the bed was strictly immobilized.Patients suspected of pulmonary embolism underwent spiral CT pulmonary angiography and were treated accordingly if confirmed.The incidence of postoperative VTE was calculated.The?~2test was used to compare age,sex,cancer type,surgical method,preoperative and postoperative plasma d-2aggregates,the incidence of VTE in patients with medium risk and high risk,and the incidence of VTE in patients with different scores in each version of the postoperative scale.Relative Risk RR value was calculated.Results:1.A total of 86 patients with esophageal cancer and esophagogastric junction cancer were included in this study,and 27 patients with postoperative VTE were included in the whole group,with a total VTE incidence of 31.40%.2.There was no statistically significant difference in the incidence of postoperative VTE among patients of different ages,genders,cancer types,smoking history,drinking history,history of hypertension and history of diabetes.The difference of plasma d-2 polymer level before operation and at day 1,3,5 after operation between patients with VTE after operation and those without VTE was statistically significant(P<0.05),and the difference of plasma d-2 polymer level at day 7 was not statistically significant.3.In the preoperative score,the incidence of postoperative VTE was17.1%in patients evaluated as medium risk by Caprini RAM 2013,and44.4%in high-risk.The difference between the two groups was statistically significant(P<0.05),and the RR value was 2.603(95%CI was 1.230-5.508).The evaluation of Caprini RAM 2010 showed that the incidence of postoperative VTE was 11.8%in medium-risk patients and36.2%in high-risk,with no statistically significant difference.Postoperative VTE incidence was 28.4%in low-risk patients and 42.1%in medium-risk patients with improved version of Caprini RAM,and the difference was not statistically significant.4.In the postoperative score,all patients were evaluated as high risk according to the three scales.The risk of VTE in patients with the postoperative score of Caprini RAM 2013>11 was 2.371 times higher than that in patients with the score?11(95%CI=1.121-5.013),and the difference was statistically significant(P<0.05).There was no such difference in other scales.Conclusions:1.The incidence of VTE is still high in patients with esophageal cancer and esophagogastric junction cancer after perioperative anticoagulant therapy,and the existing perioperative prevention strategies of VTE still have shortcomings,which should be paid more attention to and improved in clinical work.2.In the perioperative VTE management of patients with esophageal cancer and esophagogastric junction cancer,the 2013 Caprini risk assessment scale is better for predicting the occurrence of postoperative VTE in patients,and the 2010 Caprini scale is more predictive than the improved version of Caprini scale.3.When all patients were assessed as high risk after surgery,it may still be meaningful to stratify the risk,and the risk of VTE increased significantly as the score increased. |
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