妇科腹腔镜手术对子宫切除术患者术后下肢深静脉血栓的影响

Impact of laparoscopic surgery on incidence of deep venous thrombosis in lower limbs in patients undergoing hysterectomy

目的对比观察腹腔镜手术与开腹手术对良性肿瘤妇科患者子宫切除术后凝血功能及下肢深静脉血栓(DVT)的影响。方法 2014年4月至2015年4月纳入该院因非恶性肿瘤疾病拟行子宫全切手术患者110例,其中,腹腔镜组57例,开腹手术组53例。两组患者均在全身麻醉下进行手术。观察患者术前、术毕、术后24h、术后48h、术后72h活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D);并在术后24、48和72h行双下肢超声检查明确有无DVT形成。结果两组患者术毕PT低于其余各时间点(P<0.05);术毕时和术后24hAPTT低于其余观测时间点(P<0.05);术毕时和术后24h血浆FIB水平高于其余观测时间点(P<0.05);两组间PT、APTT及FIB水平比较差异无统计学意义(P>0.05)。两组患者术后D-D水平较术前均显著升高,腹腔镜组术后24hD-D水平高于开腹手术组,术后48hD-D水平低于开腹手术组(P<0.05);腹腔镜组与开腹组术后72h内下肢DVT发生率分别为14.04%(8/57)、5.66%(3/53),组间比较差异无统计学意义(P>0.05)。结论开腹手术及腹腔镜手术均明显激活机体凝血系统,引起下肢深静脉血栓形成;与开腹手术相比,腹腔镜手术并不降低子宫切术后DVT的发生率。

Objective To explore the impact of laparoscopic surgery and that of open surgery on the coagulation function and incidence of deep venous thrombosis（DVT） in lower limbs in patients undergoing hysterectomy. Methods From April 2014 to April 2015,110 eligible patients were recruited. There was 57 patients received laparoscopic surgery, and 53 patients received open surgery for hysterectomy. All patients underwent surgery under the general anesthesia. The APTT, PT, FIB, and D-dimer was detected at 5 time points：before surgery, surgery completion, 24 h after surgery,48 h after surgery,and 72 h after surgery. All patients were scheduled to ultrasound exam in lower limbs to detect the DVT at 24,48 and 72 h after surgery. Results Both groups showed decreased PT at surgery completion as compared with other time points （P〈0.05） ,decreased APTT at surgery completion and 24 h after surgery as compared with other time points（P〈0.05）, and increased FIB at surgery completion and 24 h after surgery as compared with other time points（P〈0.05）. No significant difference was found in APTT,PT, and FIB at each time points between two groups（P〈0.05）. Both groups showed increased D-dimer after surgery compared with that before surgery; the laparoscopic group showed higher D-dimer at 24 h after surgery,and lower D-direct at 48 h after surgery than open group（P〈0.05）. The incidence of DVT in laparoscopic group and open group was 14.04 （8/57） and 5.66 % （3/53）, respectively,with no significant difference between two groups（P〈0.05）. Conclusion Both the laparoscopic surgery and open surgery will activate the coagulation system, and lead to DVT;as compared with open surgery,the laparoscopic surgery could not reduce the incidence of DVT in lower limbs in patients undergoing hysterectomy.