老年盆腔器官脱垂手术前单剂药物性血栓预防与出血及伤口并发症风险
本研究为回顾性队列研究，纳入2016年1月至2023年5月在两家学术医疗中心接受脱垂手术、年龄≥61岁且Caprini评分≥5的静脉血栓栓塞高危女性。808例（35.5%）接受术前单剂药物性血栓预防，分析显示该预防措施与出血及伤口并发症复合终点无显著关联（调整OR 1.29，95%CI 0.87-1.90），支持在高危良性妇科患者中使用。
要点
- 年龄≥61岁、Caprini评分≥5的脱垂手术患者中，35.5%接受术前单剂药物性血栓预防。
- 药物性血栓预防与出血及伤口并发症复合终点无显著关联（调整OR 1.29，95%CI 0.87-1.90）。
- 研究支持在静脉血栓栓塞高危的良性妇科手术患者中使用术前单剂药物性血栓预防。
核心结论
- 在Caprini评分≥5的老年女性盆腔重建手术中，术前单剂药物性血栓预防与出血及伤口并发症增加无关，支持其用于有静脉血栓栓塞风险的良性妇科患者。
研究设计与样本
- 回顾性队列研究，纳入两家学术医疗中心2016年1月至2023年5月接受脱垂手术、年龄≥61岁且Caprini评分≥5的女性。
- 共2761例老年脱垂手术患者，其中2279例（82.5%）Caprini评分≥5，808例（35.5%）接受术前单剂药物性血栓预防。
主要发现
- 接受药物性血栓预防者更可能有更高BMI、癌症史、既往静脉血栓栓塞、卒中及慢性抗凝药使用。
- 接受药物性血栓预防者更可能接受腹腔镜或机器人途径（37.3% vs 25.1%，p<.01）、合并子宫切除术（48.0% vs 42.5%，p=.01）、全身麻醉（98.0% vs 93.9%，p<.01）及当日出院（80.8% vs 70.3%，p<.01）。
- 出血及伤口并发症发生率为5.1%，静脉血栓栓塞发生率为0.5%。
- 多因素分析显示药物性血栓预防与出血及伤口并发症无关联（调整OR 1.29，95%CI 0.87-1.90）。
关键数值与推荐
- 主要结局为术后8周内复合出血及伤口不良事件，包括估计失血量≥500 mL、手术部位感染、伤口裂开、输血及血肿。
- 药物性血栓预防为切口前皮下注射普通肝素或低分子量肝素单剂。
- 静脉血栓栓塞高危定义为Caprini风险评估模型评分≥5。
临床怎么用
- 对年龄≥61岁、Caprini评分≥5且拟行脱垂手术的良性妇科患者，可考虑术前单剂药物性血栓预防而不必担心显著增加出血或伤口并发症。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
STUDY OBJECTIVE: Older women pursuing surgical management of pelvic organ prolapse are often at high risk for venous thromboembolism (VTE), yet administration of preoperative pharmacologic thromboprophylaxis (PTX) may increase risk of wound complications and bleeding. We sought to determine the association between PTX and bleeding or wound complications in older women at elevated risk for VTE undergoing prolapse surgery. DESIGN: Retrospective cohort study. SETTING: Two academic medical centers. PATIENTS: Women ≥61 years of age at elevated risk for VTE by the Caprini risk assessment model (score ≥5) undergoing prolapse surgery from January 2016 to May 2023. INTERVENTIONS: Single preoperative dose of PTX (subcutaneous unfractionated or low-molecular weight heparin before incision). MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite wound and bleeding adverse event, which included estimated blood loss ≥500 mL, surgical site infection, wound dehiscence, transfusion, and hematoma within 8 weeks post-surgery. Of 2,761 older patients undergoing prolapse surgery, 2,279 (82.5%) had a Caprini score ≥5. Of these, 808 (35.5%) received PTX. PTX was associated with higher body mass index (BMI), history of cancer, prior VTE, stroke, and chronic anticoagulant use. Patients who received PTX were more likely to undergo laparoscopic or robotic approach (37.3% vs 25.1%, p <.01), concomitant hysterectomy (48.0% vs 42.5%, p = .01), general anesthesia (98.0% vs 93.9%, p <.01), and same-day discharge (80.8% vs 70.3%, p <.01). The incidence of bleeding and wound complications was 5.1%, and the incidence of VTE was 0.5%. On multivariable analysis, there was no association between PTX and bleeding and wound complications (adjusted OR 1.29, 95% CI 0.87-1.90). CONCLUSION: PTX administration in older women with Caprini score of ≥5 undergoing reconstructive pelvic surgery was not associated with increased bleeding and wound complications, which supports its use in benign gynecologic patients at risk for VTE.
引用
- Zuo SW, Warner KJ, Orris SR, et al. Risk of Complications in Older Patients Receiving Single-Dose Pharmacologic Thromboprophylaxis Prior to Prolapse Surgery. J Minim Invasive Gynecol. 2026. PMID: 42214460. doi:10.1016/j.jmig.2026.05.019
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。