2025 年第 6 期 第 20 卷

泌尿外科患者手术后下肢深静脉血栓形成的原因及处理措施

Causes and management measures of lower limb deep venous thrombosis in patients undergoing urology surgery

作者：韩精超李滢昊刘倍倍任行柳金顺金石华陈达

英文作者：Han Jingchao Li Yinghao Liu Beibei Ren Xing Liu Jinshun Jin Shihua Chen Da

单位：首都医科大学附属北京世纪坛医院泌尿外科，北京100038

英文单位：10.3760/j.issn.1673-4777.2025.06.024

关键词：下肢深静脉血栓形成；泌尿外科；处理措施

英文关键词：】Lowerlimbdeepvenousthrombosis;Urologysurgery;Managementmeasures

• 摘要：

• 目的 探讨泌尿外科患者手术后下肢深静脉血栓形成（DVT）的原因及处理措施。方法 收集2016年6月至2023年6月首都医科大学附属北京世纪坛医院泌尿外科手术后下肢DVT 58例患者的临床资料行回顾性分析。总结治疗结果和预后。结果 58例患者中50例为恶性肿瘤切除术后，占86.2%。超重或肥胖者39例，占67.2%。吸烟者30例，占51.7%。其中42例无明显临床症状，筛查D-二聚体时被发现，16例有不同程度的下肢疼痛、肿胀、活动受限、皮肤苍白、腓肠肌握痛试验阳性。58例患者均给予卧床休息，抬高患肢20°～30°，用低分子肝素钙85 IU/kg，每12小时皮下注射1次，疗程10～14 d，后3 d加用华法林3 mg/次，1次/d口服，华法林维持3～6个月。58例患者均保守治疗成功，1例患者因术后2 d并发肺栓塞，给予联合下腔静脉滤器置入治疗，6个月时复查血栓已消失。所有患者随访（20±14）个月，均无DVT复发，无脑梗死等严重并发症发生。1例输尿管癌患者术后9个月死于癌症复发转移。结论 泌尿外科手术后下肢DVT发病率并不低，下肢DVT的高危因素有恶性肿瘤根治术、肥胖、吸烟等。术后检测D-二聚体水平有利于早期发现下肢DVT。一旦发生下肢DVT后应积极处理，术后用低分子肝素抗凝治疗效果较好。

• Objective To investigate the causes and management measures of lower limb deep venous thrombosis (DVT) in patients undergoing urology surgery. Methods From June 2016 to June 2023, the clinical data of 58 patients with lower limb DVT after surgery at Department of Urology, Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. The treatment results  and prognosis were summarized. Results Of the 58 patients, 50 cases (86.2%) were malignant tumors after resection. Thirty-nine cases (67.2%) were overweight or obese, and 30 cases (51.7%) were smokers. Among them, 42 cases had no obvious clinical symptoms and were found during screening for D-dimer, and 16 cases had varying degrees of lower limb pain, swelling, limited mobility, pale skin, and positive gastrocnemius muscle grip test. All 58 patients were given bed rest, with the affected limb elevated by 20°-30°. Low molecular weight heparin calcium was administered subcutaneously at a dose of 85 IU/kg every 12 h for a treatment period of 10-14 d. Warfarin was also administered orally at a dose of 3 mg/time once a day for the next 3 d. Warfarin was maintained for 3-6 months. All 58 patients were successfully treated with conservative treatment. One patient developed pulmonary embolism 2 d after operation and was treated with inferior vena cava filter implantation, and the thrombus disappeared 6 months later. All patients were followed up for (20±14) months, and no DVT recurrence, cerebral infarction and other serious complications occurred. One patient with ureteral cancer died of cancer recurrence and metastasis 9 months after surgery. Conclusion The incidence of lower limb DVT after urological surgery is not low. The risk factors of lower limb DVT include radical resection of malignant tumors, obesity, smoking and so on. Postoperative detection of D-dimer level is beneficial to the early detection of lower limb DVT. Once lower limb DVT occurs, it should be treated actively. The effect of anticoagulation with low molecular weight heparin after operation is better.