妇科腹腔镜手术对子宫切除术患者术后下肢深静脉血栓的影响

发布时间：2018-02-21 11:31

本文关键词： 腹腔镜子宫切除术静脉血栓形成血液凝固　出处：《重庆医学》2015年35期 　论文类型：期刊论文

【摘要】：目的对比观察腹腔镜手术与开腹手术对良性肿瘤妇科患者子宫切除术后凝血功能及下肢深静脉血栓(DVT)的影响。方法 2014年4月至2015年4月纳入该院因非恶性肿瘤疾病拟行子宫全切手术患者110例,其中,腹腔镜组57例,开腹手术组53例。两组患者均在全身麻醉下进行手术。观察患者术前、术毕、术后24h、术后48h、术后72h活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D);并在术后24、48和72h行双下肢超声检查明确有无DVT形成。结果两组患者术毕PT低于其余各时间点(P0.05);术毕时和术后24hAPTT低于其余观测时间点(P0.05);术毕时和术后24h血浆FIB水平高于其余观测时间点(P0.05);两组间PT、APTT及FIB水平比较差异无统计学意义(P0.05)。两组患者术后D-D水平较术前均显著升高,腹腔镜组术后24hD-D水平高于开腹手术组,术后48hD-D水平低于开腹手术组(P0.05);腹腔镜组与开腹组术后72h内下肢DVT发生率分别为14.04%(8/57)、5.66%(3/53),组间比较差异无统计学意义(P0.05)。结论开腹手术及腹腔镜手术均明显激活机体凝血系统,引起下肢深静脉血栓形成;与开腹手术相比,腹腔镜手术并不降低子宫切术后DVT的发生率。
[Abstract]:Objective to compare the effects of laparoscopy and laparotomy on coagulation function and DVT in patients with benign tumor after hysterectomy. Methods from April 2014 to April 2015, the patients were included in the hospital because of non-malignant tumor. 110 patients with diseases who are planning to undergo total hysterectomy, There were 57 cases in the laparoscopic group and 53 cases in the open operation group. The patients in both groups were operated under general anesthesia. The activated partial thromboplastin time (APTTT), prothrombin time (PTT), fibrinogen (FB) D-dimer (D-D) were observed at 24 h, 48 h and 72 h after operation. The results showed that there was no DVT formation in both groups after 24 h, 48 h and 72 h. Results the PT of the two groups was low after operation. The levels of plasma FIB at the end of operation and 24 hours after operation were higher than those at the other observation time points (P0.05). There was no significant difference in the levels of PTT and FIB between the two groups. The level of D-D after operation was significantly higher than that before operation. The D-D level in the laparoscopic group was higher than that in the open operation group at 24 hours after operation. The incidence of lower extremity DVT in laparoscopy group and laparotomy group was 14.04 / 857 / 5.66 / 53, respectively, and there was no significant difference between the two groups (P 0.055.Conclusion both laparoscopy and laparotomy can activate the blood coagulation system of the body obviously, P 0.05), the incidence of lower extremity DVT in laparoscopy group and laparotomy group is 14.04 / 857 / 5.66g / 53.Conclusion there is no significant difference between the two groups (P 0.05). Compared with open surgery, laparoscopic surgery did not reduce the incidence of DVT after hysterectomy.
【作者单位】：重庆市妇幼保健院麻醉科;重庆医科大学附属第一医院麻醉科;
【基金】：重庆市科委科技攻关基金资助项目(cstc2012gg-yyjs10053)
【分类号】：R713.42

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