腹腔镜胆囊切除术对凝血系统的影响
发布时间：2019-03-24 15:15
【摘要】：目的：目前国内外对于手术后下肢静脉血栓形成(DVT)的研究逐渐增多,但腹腔镜胆囊切除后出现(DVT)的并发症的文献报道并不多,深静脉血栓的形成是一个潜在的致死致残的并发症,在肝胆、妇产、胃及泌尿外科等开展腹腔镜手术的疾病都有术后发生深静脉血栓的报道,但发生率各家报道差异较大,基于此,本研究探讨腹腔镜胆囊切除术对患者凝血系统的影响。方法：选取2014年03月至2014年08月在包头医学院一附院普外科行胆囊切除术的住院患者75例为研究对象,将该组患者按照手术方式的不同分为开腹胆囊切除术患者31例(开腹组)和腹腔镜胆囊切除术患者44例(腹腔镜组),所有患者于术前1天、手术后24小时术后72小时抽静脉血检测血小板计数(PLT),凝血酶原时间(PT),部分凝血酶原时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB), D-二聚体(DD),并于术后3天行下肢血管彩超。各时间点抽取的样品,经过预处理后送检验科,用ELISA(酶联免疫吸附试验)检测D-Dimer、FIB、TT、PLT、APTT及PT的值和术后3天下肢静脉彩超结果并记录。比较两组患者的手术疗效、凝血系统相关指标、下肢深静脉血栓的形成情况以及出院前的生活质量。采用SPSS 15.0软件,计量资料用(x±s)表示,如凝血指标、手术时间、疼痛评分等指标采用两独立样本t检验比较,计数资料采用百分比表示,如术后并发症、胆管损伤率等采用卡方检验,检验水准α=0.05,以P0.05认为差异具有统计学意义。结果：两组的手术成功率无统计学意义(P0.05)。观察组的手术时间、术中出血量、术后肛门排气时间、肠鸣音恢复时间、住院时间少于对照组,胆总管损伤率、术后疼痛评分、肠粘连率低于对照组,有统计学意义(P0.05)。两组术前24h的凝血系统指标血小板计数(PLT),凝血酶原时间(PT),部分凝血酶原时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB),D-二聚体(DD)均无统计学意义(P0.05)。两组术后24h的PLT、PT、APTT、TT、FIB、DD之间差异无统计学意义(P0.05)。两组术后72h的PLT、PT、APTT、TT、FIB、DD之间差异无统计学意义(P0.05)。两组患者术后下肢静脉血栓的发生率无统计学意义(P0.05)。观察组出院前在角色受限、躯体疼痛、总体健康、生命活力等方面的生活质量高于对照组,有统计学意义(P0.05)。结论腹腔镜胆囊切除术的手术疗效好于传统开放性手术,具有创伤小、术后出血少、恢复快、并发症少等优点,且气腹与体位的共同作用未显著增加对患者血凝状态影响,能够显著提高患者术后的生活质量,是一种值得推广的手术方式。
[Abstract]:Objective: at present, there are more and more studies on (DVT) of lower extremity venous thrombosis after laparoscopic cholecystectomy, but there are few reports about the complications of (DVT) after laparoscopic cholecystectomy. The formation of deep venous thrombosis (DVT) is a potentially fatal and disabling complication. Deep venous thrombosis (DVT) has been reported in hepatobiliary, gynecological, gastric and urological diseases after laparoscopic surgery, but the incidence of DVT varies greatly from one country to another. The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on coagulation system in patients. Methods: from March 2014 to August 2014, 75 inpatients who underwent cholecystectomy in the General surgery Department of the first affiliated Hospital of Baotou Medical College were selected as subjects. The patients were divided into open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44) according to different operation methods. All patients were on the first day before the operation, and all the patients were divided into two groups: open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44). Platelet count (PLT), prothrombin time (PT), partial prothrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD), 24 hours after operation and 72 hours after operation The blood vessels of the lower extremities were examined by color Doppler ultrasonography on the 3rd day after operation. The samples were pre-treated and sent to the laboratory. The values of D, B, T, PLT, APTT and PT were detected by enzyme-linked immunosorbent assay (ELISA), and the results of color Doppler ultrasonography of lower limb vein were recorded 3 days after operation. The results of operation, coagulation system, deep venous thrombosis (DVT) and quality of life (QOL) before discharge were compared between the two groups. Using SPSS 15.0 software, the measurement data were expressed by (x 卤s), such as coagulation index, operation time, pain score and other indexes were compared by two independent sample t-test, the counting data were expressed as percentage, such as postoperative complications. The chi-square test was used to test the bile duct injury rate, 伪 = 0.05, the difference was statistically significant (P0.05). Results: there was no significant difference in the success rate of operation between the two groups (P0.05). The operative time, intraoperative bleeding, postoperative anal exhaust time, recovery time of intestinal sound, hospitalization time, common bile duct injury rate, postoperative pain score and intestinal adhesion rate in the observation group were lower than those in the control group, and the postoperative pain score and intestinal adhesion rate were lower in the observation group than in the control group. There was statistical significance (P0.05). Platelet count (PLT), prothrombin time (PT), partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD) had no statistical significance (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 24 hours after operation (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 72 hours after operation (P0.05). There was no significant difference in the incidence of lower extremity venous thrombosis between the two groups (P0.05). Before discharge, the quality of life in the observation group was significantly higher than that in the control group in role limitation, body pain, overall health and vitality (P0.05). Conclusion Laparoscopic cholecystectomy has the advantages of less trauma, less bleeding, faster recovery and less complications than traditional open cholecystectomy, and the combined action of pneumoperitoneum and body position has no significant effect on the hemagglutination status of the patients. Can significantly improve the quality of life of patients after surgery, is a worthy of promotion of surgery.
【学位授予单位】：内蒙古大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4
本文编号：2446437
[Abstract]:Objective: at present, there are more and more studies on (DVT) of lower extremity venous thrombosis after laparoscopic cholecystectomy, but there are few reports about the complications of (DVT) after laparoscopic cholecystectomy. The formation of deep venous thrombosis (DVT) is a potentially fatal and disabling complication. Deep venous thrombosis (DVT) has been reported in hepatobiliary, gynecological, gastric and urological diseases after laparoscopic surgery, but the incidence of DVT varies greatly from one country to another. The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on coagulation system in patients. Methods: from March 2014 to August 2014, 75 inpatients who underwent cholecystectomy in the General surgery Department of the first affiliated Hospital of Baotou Medical College were selected as subjects. The patients were divided into open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44) according to different operation methods. All patients were on the first day before the operation, and all the patients were divided into two groups: open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44). Platelet count (PLT), prothrombin time (PT), partial prothrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD), 24 hours after operation and 72 hours after operation The blood vessels of the lower extremities were examined by color Doppler ultrasonography on the 3rd day after operation. The samples were pre-treated and sent to the laboratory. The values of D, B, T, PLT, APTT and PT were detected by enzyme-linked immunosorbent assay (ELISA), and the results of color Doppler ultrasonography of lower limb vein were recorded 3 days after operation. The results of operation, coagulation system, deep venous thrombosis (DVT) and quality of life (QOL) before discharge were compared between the two groups. Using SPSS 15.0 software, the measurement data were expressed by (x 卤s), such as coagulation index, operation time, pain score and other indexes were compared by two independent sample t-test, the counting data were expressed as percentage, such as postoperative complications. The chi-square test was used to test the bile duct injury rate, 伪 = 0.05, the difference was statistically significant (P0.05). Results: there was no significant difference in the success rate of operation between the two groups (P0.05). The operative time, intraoperative bleeding, postoperative anal exhaust time, recovery time of intestinal sound, hospitalization time, common bile duct injury rate, postoperative pain score and intestinal adhesion rate in the observation group were lower than those in the control group, and the postoperative pain score and intestinal adhesion rate were lower in the observation group than in the control group. There was statistical significance (P0.05). Platelet count (PLT), prothrombin time (PT), partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD) had no statistical significance (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 24 hours after operation (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 72 hours after operation (P0.05). There was no significant difference in the incidence of lower extremity venous thrombosis between the two groups (P0.05). Before discharge, the quality of life in the observation group was significantly higher than that in the control group in role limitation, body pain, overall health and vitality (P0.05). Conclusion Laparoscopic cholecystectomy has the advantages of less trauma, less bleeding, faster recovery and less complications than traditional open cholecystectomy, and the combined action of pneumoperitoneum and body position has no significant effect on the hemagglutination status of the patients. Can significantly improve the quality of life of patients after surgery, is a worthy of promotion of surgery.
【学位授予单位】：内蒙古大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4
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