有无气腹腔镜下胆囊切除术对机体凝血及纤溶影响的对比观察

Contrast Observation for the Influence of Pneumoperitoneum and Suspensory During Laparoscopic Cholecystectomy on Patients' Blood-gas Parameter and Circulation

目的:对比观察气腹腹腔镜胆囊切除术(PLC)与悬吊腹腔镜胆囊切除术(SLC)对机体凝血及纤溶功能的影响,通过凝血及纤溶指标的检测,评估机体发生深静脉血栓(DAT)的危险性。方法:随机选择腹腔镜胆囊切除术患者共200例,分为气腹腹腔镜组(A组,n=100例)和悬吊腹腔镜组(B组,n=100例)。分别记录两组术前24 h、术中气腹后20 min、术后24 h即时血小板计数(PLT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、凝血酶原时间(PT)、血浆凝血酶时间(TT)、D-二聚体指标值。结果:A组术中与术前、术后比较,各指标均有统计学意义(P<0.05),术前与术后比较,各指标无统计学意义(P>0.05)。B组各指标比较均无明显差别,均无统计学意义(P>0.05)。两组间术前、术后,各指标比较均无明显差别,均无统计学意义(P>0.05),术中各指标比较均有统计学意义(P<0.05)。结论:PLC对凝血及纤溶指标影响大,而SLC影响小,避免了CO2气腹对人体的不良影响,减少深静脉血栓(DVT)及肺栓塞(PE)的发生。对于凝血纤溶功能不全患者、老年患者、手术时间长的患者,认为选择SLC可增加手术安全性,减少术后并发症的发生。

Objective： This paper aimed at the comparative observation on the affection of Coagulation and Fibrinolysis System between PLC and SLC. By detecting the index of the blood coagulation and fibrinolysis, it can evaluate the risk of DAT. Methods： 200 cases of calculous cholecystitis and gallbladder polyps are selected randomly, undergoing peritoneoscope cholecystectomy under general anaesthesia and devided in to pneumoperi- toneum laparoscopic group （Group A, n = 100） and suspension laparoscopic group （Group B, n = 100） randomly. Recording The PLT of 24 hours before the surgery of the two groups, PLT of 20 minutes after pneumoperi- toneum during surgery, PLT of 24 hours after surgery, activated partial thromboplastin time （APTT）, fibrinogen（FIB）, prothrombin time （PT）, plasma thrombin time （TT） and the index value of D - Dimer. Results： Comparing the time before/after and during the operation of group A, all the indexes have statistical signifi- cance（P 〈 0.05）; Comparing the time before/after the operation, all the indexes have no statistical significance （P 〉 0.05）. group B has no obvious difference or statistical significance（ P 〉0.05）. Comparing the time before /after the operation of two groups , all the indexes have no obvious difference or statistical significance （P 〉 0.05） ; during the operation, all the indexes no statistical significance（P 〈 0.05 ）. Conclusions： PLC has great af- fections on PLT and relate indexes, But the SLC has small affections, which avoids the bad affection from carbon dioxide pneumoperitoneum and lower the possibility of deep venous thrombosis（DVT）and pulmonary em- bolism（PE）. SLC is better for the patients of coagulation and fibrinolysis insufficiency, elderly and long operation time, which can raise the safety of the surgery and lower the risk of postoperative complications.