国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (9): 532-536.doi: 10.3760/cma.j.cn371439-20220621-00103

• 论著 • 上一篇    下一篇

老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素分析及预测模型的建立和验证

杨莎, 杨晓华, 王苏华, 薛晓燕, 徐俊()   

  1. 川北医学院第二临床医学院 南充市中心医院胸外科,南充 637000
  • 收稿日期:2022-06-21 修回日期:2022-07-28 出版日期:2022-09-08 发布日期:2022-10-21
  • 通讯作者: 徐俊 E-mail:bijing9528518@163.com

Analysis of risk factors for deep vein thrombosis of lower extremity after thoracoscopic surgery for elderly lung cancer and establishment and validation of prediction model

Yang Sha, Yang Xiaohua, Wang Suhua, Xue Xiaoyan, Xu Jun()   

  1. Department of Chest Surgery, Nanchong Central Hospital, Second Clinical Medical College of North Sichuan Medical College, Nanchong 637000, China
  • Received:2022-06-21 Revised:2022-07-28 Online:2022-09-08 Published:2022-10-21
  • Contact: Xu Jun E-mail:bijing9528518@163.com

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摘要：

目的 分析老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素,建立列线图预测模型并进行内部验证。方法 选择2018年2月至2022年2月在南充市中心医院行胸腔镜根治术治疗的183例老年肺癌患者作为研究对象。根据术后1个月内有无下肢深静脉血栓将患者分为下肢深静脉血栓组（n=61）和非下肢深静脉血栓组（n=122）。对老年肺癌胸腔镜手术后下肢深静脉血栓形成进行单因素及多因素分析,根据多因素分析结果构建列线图预测模型,并对模型进行验证。结果 下肢深静脉血栓组与非下肢深静脉血栓组患者吸烟史（χ2=13.40,P<0.001）、术前化疗（χ2=8.79,P=0.003）、手术方式（χ2=7.97,P=0.005）、手术时间（t=7.23,P<0.001）、术后卧床时间（t=10.40,P<0.001）、合并糖尿病（χ2=6.37,P=0.012）、合并高脂血症（χ2=9.58,P=0.002）、术前D-二聚体（t=13.08,P<0.001）、术前纤维蛋白原（t=5.84,P<0.001）、术前血小板计数（t=7.01,P<0.001）差异均具有统计学意义。logistic回归分析结果显示,术前化疗（OR=2.45,95%CI为1.05~5.71,P=0.038）、手术方式（OR=2.55,95%CI为1.14~5.73,P=0.023）、术后卧床时间（OR=1.50,95%CI为1.24~1.81,P<0.001）、合并糖尿病（OR=3.60,95%CI为1.05~12.33,P=0.042）、术前D-二聚体（OR=1.01,95%CI为1.01~1.01,P<0.001）均为老年肺癌胸腔镜手术后下肢深静脉血栓形成的独立影响因素。列线图预测下肢深静脉血栓相关因素的C-index为0.86（95%CI为0.81~0.93）,校准曲线显示本模型预测下肢深静脉血栓形成的相关性良好。结论 术前化疗、手术方式、术后卧床时间、合并糖尿病、术后D-二聚体水平为老年肺癌胸腔镜术后下肢深静脉血栓形成的影响因素,本研究建立的列线图预测模型对老年肺癌胸腔镜术后下肢深静脉血栓形成预测具有较高的准确性与区分度。

关键词: 肺肿瘤, 老年人, 胸腔镜检查, 静脉血栓形成, 危险因素

Abstract:

Objective To analyze the risk factors of lower extremities deep vein thrombosis after thoracoscopic surgery in elderly patients with lung cancer, establish a nomogram prediction model and conduct internal verification. Methods A total of 183 elderly patients with lung cancer who underwent thoracoscopic radical resection in Nanchong Central Hospital from February 2018 to February 2022 were selected as the study subjects. According to the presence or absence of deep venous thrombosis of the lower extremities within one month after operation, the patients were divided into lower extremities deep venous thrombosis group （n=61） and non-deep lower extremities venous thrombosis group （n=122）. Univariate and multivariate analyses of deep venous thrombosis of lower extremities after thoracoscopic surgery for lung cancer in the elderly were performed, and a nomogram prediction model was constructed according to the multivariate analysis results, and the model was verified. Results There were statistically significant differences in smoking history （χ2=13.40, P<0.001）, preoperative chemotherapy （χ2=8.79, P=0.003）, surgical method （χ2=7.97, P=0.005）, operation time （t=7.23, P<0.001）, postoperative bed rest time （t=10.40, P<0.001）, combined with diabetes （χ2=6.37, P=0.012）, combined with hyperlipidemia （χ2=9.58, P=0.002）, preoperative D-dimer （t=13.08, P<0.001）, preoperative fibrinogen （t=5.84, P<0.001） and preoperative platelet count （t=7.01, P<0.001） between the lower extremity deep venous thrombosis group and the non-lower extremity deep venous thrombosis group. The results of multivariate logistic regression analysis showed that preoperative chemotherapy （OR=2.45, 95%CI： 1.05-5.71, P=0.038）, surgical method （OR=2.55, 95%CI： 1.14-5.73, P=0.023）, postoperative bed rest time （OR=1.50, 95%CI： 1.24-1.81, P<0.001）, combined with diabetes （OR=3.60, 95%CI： 1.05-12.33, P=0.042）, and preoperative D-dimer （OR=1.01, 95%CI： 1.01-1.01, P<0.001） were all independent risk factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The C-index of nomogram for predicting lower extremity deep vein thrombosis-related factors was 0.86 （95%CI： 0.81-0.93）. The calibration curve showed that the model had a good correlation in predicting lower extremities deep venous thrombosis. Conclusion Preoperative chemotherapy, surgical method, postoperative bed rest time, combined with diabetes, and postoperative D-dimer level are influence factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The nomogram prediction model established in this study has high accuracy and discrimination for the prediction of lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery.

Key words: Lung neoplasms, Aged, Thoracoscopy, Venous thrombosis, Risk factors