CAJ | 학술논문

目的探讨食管癌贲门癌患者围手术期血浆D-二聚体的水平变化及其临床意义.方法检测71例食管癌贲门癌患者术前及术后第1、4、7、10天的血浆D-二聚体水平,应用SPSS 19.0软件分析围手术期D-二聚体水平的变化规律及其临床意义.结果 (1)分期越晚的食管癌贲门癌患者其术前外周血D-二聚体水平越高[0期:(141.5 ±71.4) μg/L;Ⅰ期:(205.5±89.0) μg/L;Ⅱ期:(267.1±123.4) μg/L;Ⅲ期:(446.5 ±227.9) μg/L;Ⅳ期:(289.0±0.0)μg/L],且D-二聚体水平与患者年龄、性别、病理类型等无明显相关(P＞0.05);(2)食管癌贲门癌患者术后第1天血浆中D-二聚体水平升至最高[(1 193.0±670.5)μg/L],第4天明显回落[(893.2±287.5)μg/L],第7天再次升高[(1 089.1±178.9) μg/L],10d时缓慢下降[(1 043.8±202.9)μg/L].结论 (1)术前外周血D-二聚体水平与食管癌贲门癌分期呈正相关;(2)手术创伤及术后早期弥漫性微血栓可导致血浆中D-二聚体水平明显升高,术后第7天D-二聚体再次升高考虑与患者术后前期卧床,导致体内血栓形成有关,但随着患者活动量增加,其水平逐渐下降.如患者手术7d后D-二聚体持续性升高,需警惕体内血栓形成可能.
목적 탐토식관암분문암환자위수술기혈장D-이취체적수평변화급기림상의의.방법 검측71례식관암분문암환자술전급술후제1、4、7、10천적혈장D-이취체수평,응용SPSS 19.0연건분석위수술기D-이취체수평적변화규률급기림상의의.결과 (1)분기월만적식관암분문암환자기술전외주혈D-이취체수평월고[0기:(141.5 ±71.4) μg/L;Ⅰ기:(205.5±89.0) μg/L;Ⅱ기:(267.1±123.4) μg/L;Ⅲ기:(446.5 ±227.9) μg/L;Ⅳ기:(289.0±0.0)μg/L],차D-이취체수평여환자년령、성별、병리류형등무명현상관(P＞0.05);(2)식관암분문암환자술후제1천혈장중D-이취체수평승지최고[(1 193.0±670.5)μg/L],제4천명현회락[(893.2±287.5)μg/L],제7천재차승고[(1 089.1±178.9) μg/L],10d시완만하강[(1 043.8±202.9)μg/L].결론 (1)술전외주혈D-이취체수평여식관암분문암분기정정상관;(2)수술창상급술후조기미만성미혈전가도치혈장중D-이취체수평명현승고,술후제7천D-이취체재차승고고필여환자술후전기와상,도치체내혈전형성유관,단수착환자활동량증가,기수평축점하강.여환자수술7d후D-이취체지속성승고,수경척체내혈전형성가능.
Objective To evaluate the value of detecting the perioperative plasma D-dimer level in patients with esophageal cancer or esophageal gastric junction cancer.Methods 71 patients with esophageal carcinoma or esophageal gastric junction cancer who received operation were enrolled in this study.Plasma D-dimer lever before the operation and on 1st,4th,7th,10th day postoperation were detected and to find the relation between the D-dimer level and patients clinical characters.Results Plasma D-dimer lever before the operation was higher when the stage was later in esophageal cancer or in the esophageal gastric junction cancer [stage 0:(141.5 ± 71.4) μg/L;stage Ⅰ:(205.5 ± 89.0) μg/L;stage Ⅱ:(267.1 ±123.4) μg/L;stage Ⅲ:(446.5±227.9) μg/L;stage Ⅳ:(289.0±0.0) μg/L],and there was no relation with other clinical characters.Plasma D-dimer level reach the max on 1 st day postoperation [(1 193.0 ±670.5) μg/L],and decreasing on 4th day [(893.2 ±287.5) μg/L];it rise again on 7thday postoperation [(1 089.1± 178.9) μg/L],and then drop down on 10th day [(1 043.8± 202.9) μg/L].Conclusion Plasma D-dimer lever before the operation was positive relative with the stage of esophageal cancer or esophageal gastric junction cancer.Plasma D-dimer level rise after operation.It reach max on 1 st day because the surgical trauma and microthrombus,and decrease signicicantly on 4th day.It rise again on 7th day,and then,it decrease gradually.If it rise after 7 days postoperation,deep venous thrombosis (DVT) and pulmonary thromboembolism(PTE) should be considered.