腹腔镜与开腹全子宫切除术患者血栓前状态的检测

Evaluations of pre-thromboembolic state in patients undergoing total abdominal or laparoscopic hysterectomy

目的探讨手术和术式对人体凝血与纤溶的影响。方法采用凝固法、酶联免疫法、发色底物法检测20例无血栓形成高危因素的患者腹腔镜与开腹全子宫切除术后凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FG)、D-二聚体(D-Dimer)、抗凝血酶-Ⅲ(AT-Ⅲ,C)的变化。结果 PT在术后明显缩短(P<0.05)、D-Dimer明显升高(P<0.05)、AT-Ⅲ活性明显降低(P<0.05),APTT、FG未发生明显变化(P>0.05)。腹腔镜术后与开腹术后相比:PT、D-Dimer、AT-Ⅲ活性存在显著性差异(P<0.05)。结论手术使患者处于血栓前状态,但腹腔镜对机体的影响较小,腹腔镜可能成为全子宫切除术的最佳术式;但对于有高危因素的患者也应加强围手术期管理,预防血栓性疾病发生。

Objective To investigate the influences of total abdominal and laparoscopical hysterectomy on coagulation and fibrolytic functions.Methods Blood samples were taken from 20 patients without high-risk factor of thrombosis before and after total abdominal and laparoscopical hysterectomy.The values of PT,APTT,FG,D-Dimer and AT-III were measured.Results The values of PT and AT-III significantly decreased while D-Dimer significantly increased after the operations.These changes were more obvious in patients undergoing abdominal hysterectomy.No significant changes in APTT or FG were noted after hysterectomy.Conclusions Patients undergoing hysterectomy are at risk of developing thromboembolism,but the laparoscopic approach can significantly lower this risk as compared with abdominal hysterectomy.