腹腔镜手术与开腹手术对宫颈癌患者凝血功能影响的对比研究

Comparative study of laparoscopic cervical and open surgery on blood coagulation function of patients with cancer surgery

目的探讨腹腔镜宫颈癌手术与开腹手术前后的凝血功能的影响。方法选取2012年1月-2014年1月医院接受宫颈癌手术治疗的患者88例,术式选择遵从患者意愿及手术适应证,分为腹腔镜组和开腹组各44例,测量其术后0h、2h和24h的血管内皮素-1(ET-1)、血管性血友病因子(v WF)以及血栓调节蛋白(TM)的变化并作比较分析。结果术后0h、2h腹腔镜组与开腹组血浆ET-1、v WF、TM水平均较术前明显升高,且腹腔镜组升高程度明显大于开腹组,差异有统计学意义(P<0.05)。术后24h 2组间ET-1、v WF、TM水平比较差异无统计学意义(P>0.05),但均高于术前水平(P<0.01)。结论 2种手术方案均对血管造成损伤进而增加术后血栓形成的风险,且腹腔镜术对血管的损伤更加严重,但术后24h血管损伤逐渐恢复。

Objective To compare the impact of laparoscopic cervical cancer surgery and laparotomy on blood coagu- lation function. Methods 88 cases of cervical Cancer patients accepted operation treatment from January 2012 to January 2014 were selected as research subjects. According to the wishes of patients with cervical cancer and operative indication, they were divided into laparoscopic surgery （LR） group with 45 cases and laparotomy （OR） group with 43 cases. Then measured endothelin-1 （ ET-I ）, yon Willebrand factor （vWF） and thrombomodulin （TM） at 0h,2h and 24h after operation. Results After operation for Oh,2h, plasma ET-1, vWF, TM level of LR group and the OR group was significantly higher than the preoperative level, and the LR group was significantly higher than those of the OR group, the differences were statistically significant （P 〈 0.05）. After operation for 24h, there were no significant difference of ET-1 ,vWF,TM level between 2 groups （P 〉0.05） ,but the ET-1, vWF, TM level of both groups increased significantly compared with before operation （ P 〈 0.01 ）. Conclusion Both surgical methods can cause vascular endothelial injury and increase the risk of thrombosis after operation,and even more in the LR group, but it recovered gradually at 24 hours after operation .