妇科盆腔手术后下肢深静脉血栓形成的治疗和康复

Retrospective study of postoperation lower extremity deep venious thrombosis in gynecology operation

目的探讨妇产科患者手术后并发下肢深静脉血栓(DVT)的诊治要点及预防措施。方法回顾性分析1997年1月至2006年12月,共67例DVT患者的临床特点及诊断、治疗和预防的方法。结果发生DVT的高危因素为中老年妇女、肥胖,虽然原发病为盆腔恶性肿瘤发生率较高,但妇产科患者中良性肿瘤及正常妊娠妇女发生率也需要引起高度重视,尤其是正常妊娠剖宫产术后,易于忽视。诊断方法以彩色多普勒血流显像为首选,但是B超诊断应该和临床诊断结合,单纯依靠B超易于误诊。治疗采用低分子肝素抗凝治疗为主的综合治疗,均取得较好效果。术前发生下肢深静脉血栓可以采取放置腔静脉滤网的办法防止发生血栓脱落,以免引起肺栓塞。结论妇产科患者,是术后并发DVT的高危人群,应该引起高度警惕,手术后应采取包括弹力袜,压力泵,低分子肝素等综合预防措施。急性DVT保守或手术治疗均有效,低分子肝素抗凝治疗对DVT有较好疗效。术前血栓患者放置下腔静脉滤网可以有效预防肺栓塞的发生。虽然手术治疗及介入治疗有效,但是远期效果及安全性尚有争议。

Objective To investigate the fist faeters,diagnosis,treatment and prevention methods of deep vein thrombosis（DVT） in gynecology operation. Methods The medical records of 67 cases with DVT in the department of obstetric and gynecology, beijing hospital were retrospectively analyzed . Results The average age of DVT is 41. 2years ,overweight, malignant tumors are important facters in the DVT patients, nevertheless, patients with benign turners should not be ignored, especially the eessaren section patients. D-dimer and color Doppler ultrasound are very useful in the early diagnosis and treatment of the disease. The combined therapy such as socks, pump, and LMH, are useful, the materials also confirm prophlytie antieoagulation treatment should be considered in high risk patients. B type ultrasound is useful in the early diagnosis,but the diagnosis should not be excluded when the B scan is negative. Conclusion Gyneeolgy and obstetric operation with acute DVT should be pay much more attention, B type ultrasound, color Doppler, are usuall methods in the diagnosis of DVT. D-dimer is very useful in the predication of DVT, though it is too sensitive . Conservative therapy such as LMH has good effect in the treatment of the disease, surgery such as thrombectomy also has sound effects, though its safety and value are controversy.