Postoperative Pulmonary Embolism Including Asymptomatic Cases in Gynecologic Oncology

被引:8
|
作者
Okadome, Masao
Saito, Toshiaki [1 ]
Miyahara, Daisuke [5 ]
Yamanaka, Takeharu [2 ]
Kuroiwa, Toshiro [3 ]
Kurihara, Yujiro [4 ]
机构
[1] Kyushu Natl Canc Ctr, Gynecol Serv, Minami Ku, Fukuoka 8111395, Japan
[2] Kyushu Natl Canc Ctr, Inst Clin Res, Fukuoka 8111395, Japan
[3] Kyushu Natl Canc Ctr, Dept Radiol, Fukuoka 8111395, Japan
[4] Kyushu Natl Canc Ctr, Dept Anesthesiol, Fukuoka 8111395, Japan
[5] Fukuoka Univ, Fac Med, Dept Obstet & Gynecol, Fukuoka 81401, Japan
关键词
Pulmonary embolism; Asymptomatic cases; Gynecologic surgery; Risk factors; Prophylaxis; PNEUMATIC CALF COMPRESSION; DEEP-VEIN THROMBOSIS; VENOUS THROMBOEMBOLISM; RISK-FACTORS; PREVENTION; PROPHYLAXIS;
D O I
10.1111/IGC.0b013e3181bdbeb5
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction: So far, there has been no report addressing the actual rate of asymptomatic pulmonary embolism (PE). The present study was conducted to clarify the incidence and the characteristics of postoperative PE including asymptomatic cases in gynecologic oncology. Methods: A total of 2107 gynecologic surgery cases that were performed from January 1996 to December 2006 at the National Kyushu Cancer Center were included. Pulmonary embolism was diagnosed using a lung scan, multi-detector row computed tomography, or pulmonary angiography. The clinical factors, including prophylaxes, were analyzed by univariate and multivariate analyses. Results: PE was diagnosed in 45 patients (2.14%). Six (13.3%) of the 45 patients had respiratory symptoms or signs, and 16 patients (35.6%) had no symptoms or signs except for a SpO(2) level decrease. PE was diagnosed within 4 days after the surgery in 42 patients (93.3%). There were 1 massive, 2 recurrent, and no fatal PEs. A multivariate analysis demonstrated the incidence of PE to be associated with age (odds ratio, 1.957; 95% confidence interval, 1.497-2.559), operation time (1.664; 1.180-2.346), body mass index (2.457; 1.735-3.479), surgical position (2.253; 1.468-3.458), and the use of a perioperative intermittent pneumatic compression device (0.389; 0.229-0.659). Conclusions: A substantial number of postoperative PEs were occult, and identification of high-risk patients and routine SpO(2) level monitoring would reduce the diagnostic delay of PE after gynecologic surgery. Increasing age, longer operation time, and obesity were risks. The use of a perioperative intermittent pneumatic compression device in multimodal conditions might thus prevent PE.
引用
收藏
页码:655 / 663
页数:9
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