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Objective:To identify the characteristics of venous thromboembolism(VTE) after lung surgery and the use of prophylactic anticoagulants. Inclusion criteria: (1) patients with primary pulmonary disease; (2) received pulmonary surgery; (3) Doppler ultrasound examination of lower extremity veins before and after operation.Methods:Patients who underwent lung surgery in our department from July 2016 to December 2017 were studied retrospectively.Results:A total of 659 patients who underwent lung surgery were analyzed, of which 58 patients had new diagnosis of VTE, after surgery with an incidence of 8.8%, and 151 patients were treated with prophylactic anticoagulants, with a total prophylactic use rate of 22.9%. According to the modified Caprini risk assessment scale, the patients were divided into three groups: low risk group(≤4 points), medium risk group(5-8 points) and high risk group(≥9 points). The proportion of prophylactic anticoagulation in each group was 4.0%(12/300), 36.3%(119/328) and 64.5%(20/31), respectively. The duration of prophylactic anticoagulation was also quite different, including 99 patients with anticoagulation for 1-3 days, 46 for 4-6 days, and 6 for 7-9 days. There was no significant difference in the incidence of VTE between patients who received prophylactic anticoagulation and patients who did not receive prophylactic anticoagulation( P>0.05). Conclusion:The incidence of VTE after pulmonary surgery is high, but the proportion of patients receiving prophylactic anticoagulation is low, and the anticoagulation course is too short, which leads to the poor preventive effect. It is suggested that the use of anticoagulants should be reasonably standardized in the future in order to improve the state of blood coagulation and prevent thrombosis.
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Objective To analyze the prognostic factors in the surgical treatment of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 93 patients [61 males and 32 females,age (64±8)years with the range of 43-84 years] with hilar cholangiocarcinoma who underwent surgical treatments in the General Hospital of the Northern Theater from January 2010 to December 2017 were collected.According to preoperative different staging and intraoperative exploration of hilar cholangiocarcinoma,corresponding operations were performed.Observation indicators:(1) surgical treatment situations;(2) tumor typing,staging and degree of differentiation:① tumor typing and staging,② degree of tumor differentiation;(3) follow-up situations;(4) analysis of prognostic factors:① univariate analysis,② multivariate analysis;(5) subgroup analysis.Follow-up using outpatient examination and telephone interview was performed to detect survival time and survival rate of patients up to December 31,2017.Kaplan-Meier method was used to calculate survival time and survival rate and to draw survival curves.Survival situations were analyzed byLog-rank test.The univariate analysis and multivariate analysis were performed using the Log-rank test and COX proportional hazard model respectively.Results (1) Surgical treatment situations:93 patients underwent surgical treatments,including 51 undergoing radical resection,23 undergoing palliative resection,16 undergoing internal biliary drainage or external drainage,3 undergoing abdominal laparotomy and intraoperative biopsy.(2) Tumor typing,staging and degree of differentiation.① Tumor typing and staging:of the 93 patients with hilar cholangiocarcinoma,Bismuth-Corlette type Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳ were detected in 26,22,9,18 and 18 patients.TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were detected in 7,34,22 and 30 patients,Mayo Clinic stage 1,2,3,4 were detected in 20,19,51 and 3 patients.② Degree of tumor differentiation:results of pathological examination showed 16 of 93 patients with highly differentiated adenocarcinoma,35 with moderately differentiated adenocarcinoma,37 with poorly differentiated adenocarcinoma,4 with mucinous adenocarcinoma and 1 with papillary adenocarcinoma.(3) Follow-up situations:93 patients were followed up for 6-36 months,with a median time of 24 months.The survival time of 93 patients was (21.4±2.1)months and the 1-,2-,3-year overall survival rates were 62.2％,34.9％ and 17.1％,respectively.(4) Analysis of prognostic factors:① results of univariate analysis showed that preoperative level of TBil,preoperative level of CA19-9,preoperative level of CA24-2,surgical methods,lymph node metastasis,vascular invasion,TNM staging,Mayo Clinic staging,degree of tumor differentiation were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2 =6.321,7.357,6.590,22.088,11.173,22.914,23.326,25.966,39.512,P＜0.05).② Results of multivariate analysis showed that preoperative level of TBil,preoperative level of CA 19-9,surgical methods,vascular invasion and degree of tumor differentiation were independent factors affecting prognosis of patients with hilar cholangiocarcinoma (odds ratio=1.002,1.001,2.690,2.626,0.420,95％ confidence interval:1.000-1.004,1.000-1.002,1.474-4.910,1.333-5.134,0.206-0.854,P＜0.05).(5) Subgroup analysis:of the 93 patients,the survival time of 51 undergoing radical resection was (28.0±2.3)months,and the 1-,2-,3-year survival rates were 75.3％,57.5％ and 25.7％,respectively;the survival time of 23 undergoing palliative resection was (14.0±2.4)months and the 1-,2-,3-year survival rates were 60.9％,13.0％,0,respectively;the survival time of 19 undergoing biliary drainage or open exploration was (8.0±2.9) months and the 1-,2-,3-year survival rates were 31.6％,7.9％,0,respectively.The survival of patients undergoing radical resection was significantly different from that of patients undergoing palliative resection,biliary drainage and open laparotomy respectively (x2 =10.939,18.343,P＜0.05).The survival of patients undergoing palliative resection was not statistically significant different from that of patients undergoing biliary drainage or exploration group (x2 =2.803,P＞0.05).Of the 35 patients with vascular invasion,the overall survival time was (7.0±2.0)months and 1-,2-,3-year survival rates were 14.5％,7.3％,0 respectively in 18 with portal vein invasion only,(10.0± 2.1)months and 37.5％,18.8％,and 18.8％ respectively in 8 with hepatic artery invasion,showing no statistically significant difference between the two groups (x2 =0.905,P＞0.05).Conclusions Preoperative level of TBil,preoperative level of CA19-9,surgical procedures,vascular invasion and degree of tumor differentiation are independent prognostic factors for patients with hilar cholangiocarcinoma.Radical resection can prolong the survival time of patients compared with other surgical treatments.
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Objective@#To evaluate the incidence of postoperative venous thromboembolism (VTE) after thoracic surgery and its characteristic.@*Methods@#This was a single-center, prospective cohort study. Patients undergoing major thoracic surgeries between July 2016 and March 2017 at Department of Thoracic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled in this study. Besides the routine examination, all patients were screened for deep venous thrombosis (DVT) by using noninvasive duplex lower-extremity ultrasonography after surgery. CT pulmonary angiography (CTPA) was carried out if patients had one of the following conditions including typical symptoms of PE, high Caprini score (>9 points) or new diagnosed postoperative DVT. Caprini risk assessment model was used to detect high risk patients. No patients received any prophylaxis of VTE before surgery. Further data was analyzed for identifying the incidence of postoperative VTE. The t-test, χ2 test or Wilcoxon rank-sum test was used to analyze the quantitative data and classification data, respectively.@*Results@#Totally 345 patients who undergoing major thoracic surgery were enrolled in this study including 145 benign diseases and 200 malignant diseases.There were 207 male and 138 female, aging from 15 to 85 years. Surgery procedures included 285 lung surgeries, 27 esophagectomies, 22 mediastinal surgeries and 11 other procedures. The overall incidence of VTE was 13.9% (48 of 345) after major thoracic surgery including 39 patients with newly diagnosed DVT (81.2%), 1 patient with PE (2.1%) and 8 patients with DVT+ PE (16.7%). The median time of VTE detected was 4.5 days postoperative. There were 89.6% (43/48) VTE cases diagnosed in 1 week. The incidence of VTE was 9.0% in patients with benign diseases, while 17.5% in malignant diseases (χ2=5.112, P<0.05). The incidence of VTE in patients with pulmonary diseases was 12.6%, among that, in patients with lung cancer and benign lung diseases was 16.4% and 7.5 % (χ2=4.946, P<0.05), respectively. Regarding to Caprini risk assessment model, the incidence of VTE in low risk patients, moderate risk patients (Caprini score 5 to 8 points)and high risk patients(≥9 points)were 0(0/77), 15.2%(33/217) and 29.4%(15/51), respectively(Z=-12.166, P<0.05). In patients with lung cancer, 98.2% of patients were moderate risk or high risk; only 3 cases scored low risk. The incidence of VTE in moderate risk and high risk patients was 13.4%(18/134) and 32.1%(9/28), respectively, while it was 0(0/3) in low risk patients.@*Conclusion@#s The overall incidence of VTE after major thoracic surgeries is 13.9%, and the incidence of VTE after lung cancer surgeries was 16.4%. Most of the VTE cases occurr within one week after the surgery. Caprini risk assessment model can identify high risk patients effectively.
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Hilar cholangiocarcinoma (HCCA) is a malignant tumor from the biliary epithelium.Its incidence is concealed,the anatomical structure is relatively complex,and the prognosis is poor.Surgical treatment is the only way to get a cure.At present,there are still many controversies in the preoperative evaluation and surgical treatment of HCCA at home and abroad.Further research on preoperative imaging diagnosis of HCCA,preoperative biliary drainage,portal vein embolization,scope of surgical resection,vascular resection and reconstruction,and orthotopic liver transplantation may provide a new reference for clinical treatment of HCCA.
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BACKGROUND@#The Previous study has indicated that the incidence of venous thromboembolism (VTE) after lung cancer surgery is not uncommon. The aim of this study is to analyze the risk factors of postoperative VTE in lung cancer patients and provide a clinical basis for further prevention and treatment of VTE.@*METHODS@#This study was a single-center study. From July 2016 to December 2017, all patients with lung cancer who underwent surgery in our department were enrolled into this study. Except routine preoperative examinations, lower extremity Doppler ultrasound was performed in all patients before and after surgery to determine whether there was any newly developed deep venous thrombosis (DVT). Patients did not receive any prophylactic anticoagulant therapy before and after surgery. Patients were then divided into VTE group and control group according to whether VTE occurred after operation. Baseline data, surgical related data (surgery type, surgical procedure, etc.) and tumor pathological data (pathological type, vascular infiltration, pathological staging, etc.) were compared between the two groups.@*RESULTS@#According to the inclusion criteria, a total of 339 patients undergoing lung cancer surgery were analyzed. There were 166 males and 173 females with an age range of 23-86 years. A total of 39 patients developed VTE after surgery, the incidence rate of postoperative VTE was 11.5%. Comparing the age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA), smoking status, underlying diseases, etc, there were no significant differences in other indicators except for significant differences in age; comparison between preoperative blood routine, blood biochemistry, coagulation, tumor markers, lung function, lower extremity venous ultrasound, preoperative carcinoembryonic antigen (CEA) levels, preoperative D-dimer levels, there were significant differences in lung function and lower extremity intermuscular vein expansion ratio. There were no significant differences in other indexes between the two groups. The duration of surgery, surgical procedure, bleeding volume, pathological type, pathological stage, vascular invasion, were compared between the two groups. There were statistical differences in surgical methods (thoracic vs thoracoscopic) and bleeding volume. There were no significant differences in other indicators. Univariate analysis showed that age, preoperative CEA level, preoperative D-dimer level, poor pulmonary function, lower extremity intermuscular vein dilation ratio, thoracotomy rate, length of surgery, and amount of bleeding were significantly risk factors (P<0.05). There were no significant correlations between pathological stage and pathological type and VTE. Multivariate logistic regression analysis showed that forced expiratory volume in one second (FEV1), surgical approach, and lower extremity intermuscular vein dilatation were independent risk factors for postoperative VTE in patients with lung cancer (P<0.05).@*CONCLUSIONS@#The results of this study suggest that FEV1, surgical procedures, and lower extremity intermuscular vein dilation are independent risk factors for postoperative VTE in patients with lung cancer.
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Aged , Female , Humans , Male , Middle Aged , Lung Neoplasms , General Surgery , Multivariate Analysis , Postoperative Complications , Risk Factors , Venous ThromboembolismABSTRACT
Objective@#To investigate the current status of prevention and treatment of venous thromboembolism (VTE) after thoracic surgery in China.@*Method@#Chinese thoracic surgeons were investigated by the online questionnaire which was based on the Chinese version of International VTE questionnaire added with 6 extra questions with Chinese characteristics.@*Results@#A total of 1 150 valid questionnaires were retrieved, accounting for about 20% of all the Chinese thoracic surgeons. The surgeons participating in this survey came from all over the country, most of whom were experienced professionals with high academic titles.For lung cancer patients, 66.96% (770/1 150) of the surgeons suggested that VTE prophylaxis should start 1 day after lung cancer resection, and 64.61% (743/1 150) of the surgeons suggested extending after discharge. For esophagestomy patients, and 48.35% (514/1 063) of the surgeons suggested that there was no need for patients to extend VTE prophylaxis after discharge. More than half of the surgeons participating in this survey made decision of the method and duration of VTE prophylaxis after lung cancer resection (53.91% (620/1 150)) or esophagectomy (52.49% (558/1 063)) depending on the clinical experience.Low molecular weight heparin was the common choice of most surgeons in VTE prophylaxis. More than half of the surgeons thought that previous history of VTE, advanced age, complicated with thrombophilia, obesity (body mass index>30 kg/m2), duration of surgery longer than 6 hours and family history of VTE were key risk factors of the occurrence of postoperative VTE.@*Conclusions@#The results of this survey are highly credible and are a good reflection of the current status of VTE prevention and treatment after thoracic surgery in China. This survey will play an important role in promoting VTE prevention and treatment in Chinese thoracic surgery department, it will also provide data support for government setting new policies, hospital construction of VTE prevention and control as well as raising physicians′ awareness.
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AIM To study the effect of glucocorticoid acetic acid cortisone on expression of CaM mRNA in hypothalamus-pituitary-adrenal axis (HPAA). METHODS Using reverse transcription polymerase chain reaction (RT-PCR),the expression of CaM mRNA was measured in HPAA of rats which were injected with acetic acid cortisone. RESULTS Acetic acid cortisone induced the expression of CaM mRNA in hypothalamus and adrenal respectively, but it had no effect significantly in pituitary. CONCLUSION These data suggest that CaM mRNA plays important role in the modulation of GC in HPAA.
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AIM To study the effect of glucocorticoid acetic acid cortisone on expression of CaM mRNA in hypothalamus pituitary adrenal axis (HPAA). METHODS Using reverse transcription polymerase chain reaction (RT PCR),the expression of CaM mRNA was measured in HPAA of rats which were injected with acetic acid cortisone. RESULTS Acetic acid cortisone induced the expression of CaM mRNA in hypothalamus and adrenal respectively, but it had no effect significantly in pituitary. CONCLUSION These data suggest that CaM mRNA plays important role in the modulation of GC in HPAA.