阿司匹林持续应用对腹腔镜胆囊切除术中和术后出血的影响

Impact of continuous use of aspirin on intraoperative and postoperative bleeding in laparoscopic cholecystectomy

目的 研究围手术期持续应用与术前7d停用阿司匹林对择期腹腔镜胆囊切除术中和术后出血及其他并发症的影响.方法 采用多中心、随机对照方法对2011年4月至2014年7月择期实施腹腔镜胆囊切除术患者进行评估.入选患者随机分为持续应用阿司匹林组和术前7d停用阿司匹林组.对比观察2组患者的术中出血量、中转开腹率、手术时间、术后出血（48 h再手术）率、腹腔引流量、术后输血事件、主要血栓栓塞性事件发生率和术后住院时间.结果 共入组118例患者,研究中退出2例.持续应用阿司匹林组57例,术前7d停用阿司匹林组59例.2组患者的术中出血量、中转开腹率、手术时间、术后出血（48 h再手术）率、腹腔引流量、术后输血事件、主要血栓栓塞性事件发生率和术后住院时间差异均无统计学意义（P＞0.05）.结论 择期行腹腔镜胆囊切除术患者围手术期持续应用阿司匹林（75～ 100 mg/d）不增加术中和术后出血风险.

Objective To study the impact of continuous use versus discontinuous use of aspirin for 7 days before operation on intraoperative and postoperative bleeding and associated complications in elective laparoscopic cholecystectomy.Methods A multicenter,randomized controlled study conducted on patients who underwent elective laparoscopic cholecystectomy was performed from April 2011 to July 2014.The enrolled patients were randomly divided into the continuous use of aspirin group and the discontinuous use of aspirin for 7 days before operation.The intraoperative bleeding,rate of conversion to laparotomy,operating time,postoperative bleeding rate （reoperation rate in 48 h）,drainage volume,postoperative blood transfusion,major thromboembolic events,and postoperative hospital stays were compared.Results 118 patients were enrolled into this study and 2 patients dropped out.Of the remaining 116 patients,57 patients were randomized to the continuous use of aspirin group and 59 patients to the discontinuous use group.The two groups showed no significant difference in intraoperative bleeding,rate of conversion to laparotomy,operating time,postoperative bleeding rate （reoperation rate in 48 h）,drainage volume,postoperative blood transfusion,major thromboembolic events and postoperative hospital stays （P ＞ 0.05）.Conclusion Continuous use of aspirin （75 ～100 mg/d） did not increase the rate of intraoperative and postoperative bleeding in the perioperative period in patients who underwent elective laparoscopic cholecystectomy.