妇科盆腔术后深静脉血栓的诊治与预防

Diagnosis,treatment and prevention of deep venous thrombosis after gynecologic operation

目的探讨妇科盆腔术后并发下肢深静脉血栓(DVT)的诊断治疗要点及预防措施。方法回顾性分析我院8例妇科DVT患者的临床特点及诊断、治疗和预防的方法。结果辅助诊断方法以彩色多普勒血流显像为最佳。治疗采用肝素或低分子肝素如速避凝抗凝治疗,均取得较好效果。全部病例确诊后即进行抗凝、溶栓治疗,血栓完全溶解1例,部分溶解7例,症状均明显改善,无肺栓塞发生。结论术前纠正贫血,术中操作精细、减轻对髂静脉及其属支的刺激,术后鼓励患者早期下床活动是预防深静脉形成的主要方法;对有高危因素者术后可考虑预防性抗凝治疗;早期诊断、及时进行抗凝、溶栓治疗对DVT有较好疗效。

Objective To describe the clinical essentials of deep venous thrombosis （DVT） after operation on pelvic and study how to choose the methods for the diagnosis, treatment and prevention of DVT. Methods The clinical characteristics, the methods of diagnosis, treatment and prevention of 8 cases with DVT were analyzed retrospectively. Results Colour-code Doppler ultrasonography was the best choice to diagnose DVT. Heparin or low molecule weight heparin （LMWH） anticoagulation was effective in postoperative DVT. All patients underwent immediately anticoagulation and thrombolysis treatment after diagnosed with DVT. Total dissolution of the thrombosis was found in 1 case,while partial dissolution was found in 7 cases.Apparent symptoms were palliative in all cases and no pulmonary thrombosis occurred. Conclusion Treating anemia preoperatively, elaborately operating for reducing stimulation to the iliac vein system intraoperatively and encouraging the patients to leave the bed as early as possible are chief methods to prevent the occurrence of DVT. Prophylactic employment of anticoagulation should be considered for patients with high risk factors. It is effective for the patients to undergo anticoagulation and thrombolysis immediately after diagnosed.