凝血及纤溶系统在腹腔镜子宫全切手术后的变化

The Change in Coagulation and Fibrinolysis System after Laparoscopic Hysterectomy Operation

目的:比较分析妇科腹腔镜子宫全切术与开腹子宫全切术对凝血及纤溶系统功能的影响。方法:选择75例接受子宫全切除术的患者,随机分为腹腔镜组38例和开腹组37例,分别于术前24h、术后24h及术后48h采用凝固法检测血浆凝血酶原时间(PT),活化部分凝血活酶时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB)水平,采用酶联免疫吸附双抗体夹心法(ELISA)测定血浆D-二聚体(D-D)的含量。自动血细胞技术分析仪测定血小板(PLT)。结果:①腹腔镜组与开腹组术前24h及术后48h血浆PT、APTT、TT、FIB、PLT、D-D水平相比差异无统计学意义(P>0.05)。②两组病人术后24h血浆PT、APTT均缩短,组间相比差异无统计学意义(P>0.05),但与术前24h相比差异有统计学意义(P<0.05)。③TT及PLT在术前24h及术后24h水平相比差异无统计学意义(P>0.05)。④FIB、D-D两组术后24h均升高,与术前相比差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05)。结论:腹腔镜子宫全切除术特殊的二氧化碳气腹的建立,头低臀高的膀胱截石位,气管插管的全麻协同作用,使患者的血流动力学发生改变,血流速度减慢,同开腹手术一样,均可使患者术后血液呈现不同程度高凝状态,从而均可增加术后下肢静脉血栓形成的危险。因此,对有高危因素的患者应加强围手术期的管理,防止血栓性疾病的发生。

Objective： To compare and analyze the effects of laparoscopic surgery and laparotomy for coagulation system in patients.Methods： Seventy-five hysterectomy patients were randomly divided into the laparoscopic surgery group with 38 and laparotomy surgery group with 37.Blood coagulation method was used to determine the plasm prothrombin time（PT）,active partial thromboplastic time（APPT）,thrombin time（TT） and fibrinogen（FIB）;and enzyme linked immunosorbent assay（ELISA） was used to measure the value of D-Dimer in blood at 24 hours before,24 and 48 hours after operation.Use automated bold cell technology to analyze platelet.Results： ①There were no significant differences between the laparoscopic surgery and laparotomy surgery groups of the contents of PT,APPT,TT,FIB,PLT and D-D in blood at 24 hours before and 48 hours after operation（P 〈0.05）.②The contents of PT and APTT decreased 24 hours and 48 hours after operation,but there were no significant differences between the laparoscopic surgery and laparotomy surgery groups（P 〈0.05）.However,there were significant differences between the results of 24 hours before and 24 and 48 hours after operation（P 〈0.05）.③ There were no significant differences between the laparoscopic surgery and laparotomy surgery groups of the content of TT and PLT at 24 hours before and 24 hours after operation（P 〈0.05）.④ The content of both FIB and D-D increased at 24 hours after operation,and this differs significantly from the content before operation（P 〈0.05）.However,there were no significant differences between the laparoscopic surgery and laparotomy surgery groups（P 〈0.05）.Conclusion： The establishment of a special carbon dioxide pneumoperitoneum,the low head and high hips bladder lithotomy position,and general anesthesia in laparoscopic hysterectomy,lead to the change of patient＇s hemodynamic,which slow down the speed of blood flow.This effect is the same as the effect in laparotomy surgery,which increases in the blood of patients showing hypercoagulable state and increase the risk of deep venous thrombosis.So we should highly care about laparoscopic patients associated with high risk factors of thrombosis,guard against the occurrence of thrombosis.