胃肠道恶性肿瘤腹腔镜手术对下肢深静脉血栓形成的临床分析

Deep vein thrombosis of the lower extremities after laparoscopic surgery for gastrointestinal cancer: Incidence and risk factors

目的分析腹腔镜与开腹胃肠道恶性肿瘤术后患者形成下肢深静脉血栓影响.方法选取2015-12/2017-12间在本院因直肠或者胃恶性肿瘤而准备进行根治性肿瘤切除手术患者158例,依据随机数字表法将其分成两组,观察组(79例)患者行腹腔镜相关手术,对照组(79例)患者行传统开腹手术;观察患者深静脉血栓形成(deep vein thrombosis,DVT)发生率、手术时间、术中出血量及术后排气、住院时间、并发症状况,患者术前与术后1、3、5 d凝血酶凝固时间(thromboplastin time,TT)、D-二聚体(D-Dimer,DD)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)及凝血酶原时间(prothrombin time,PT)和血栓弹力图(thromboelastogram,TEG)指标改变状况.结果观察组患者手术时间、发生DVT例数为209.47分±30.17分、26例,高于对照组的174.33分±30.29分、15例,术后中出血量、术后并发症人数为300.18 mL±50.29 m L、6例,低于低于对照组的379.45 m L±50.49 m L、16例,差异均有统计学意义(P<0.05);观察组术后1 d PT为12.94 s±0.88 s较术前11.19 s±0.86 s及对照组11.75 s±0.90 s延长、术后1 d APTT26.28 s±2.54 s较术前30.23 s±2.68 s及对照组30.99 s±2.51 s缩短、术后1、3、5 d DD含量1.77 s±0.23 s、2.30 s±0.45 s、2.28 s±0.46 s较术前1.29 s±0.25 s及对照组1.49 s±0.26 s、1.68 s±0.42 s、1.70 s±0.41 s升高,差异均有统计学意义(P<0.05);观察组患者术后1、3、5 d MA值分别为69.68 mm±6.48 mm、70.51 mm±6.41 mm、72.03 mm±6.89 mm较术前63.80 mm±6.52 mm和对照组65.97 mm±6.15 mm、67.02 mm±6.31 mm、69.60 mm±6.47 mm,术后1、3、5 dα值分别为70.02±4.33、70.71±4.47、73.08±4.25较术前60.20±4.29和对照组65.69±4.22、67.48±4.36、68.98±4.51显著升高,差异有统计学意义(P<0.05);DVT和非DVT患者在年龄、是否吸烟、ASA分级、肿瘤分期、是否有高血压间差异有统计学意义(P<0.05).结论腹腔镜胃肠道恶性肿瘤手术后DVT发生率要高于传统开腹手术.

AIM To compare the incidence of deep venous thrombosis （DVT） of the lower extremities after laparoscopic andopen surgery for gastrointestinal malignancies METHODS A total of 158 patients who underwent radical resection for rectal or gastric cancer at our hospital from December 2015 to December 2017 were selected and randomly divided into either an observation group （79 patients） or a control group （79 patients）. The observation group underwent laparoscopic surgery, and the control group underwent traditional laparotomy. Operative time, intraoperative blood loss, postoperative exhaust, hospital stay, complications, and preoperative and postoperative thromboplastin time （TT）, D-dimer （DD）, activated partial thromboplastin time （APTT）, prothrombin time （PT）, and thromboelastography （TEG） were compared between the two groups. RESULTS Operative time was significantly longer and the number of DVT cases was significantly more in the observation group than in the control group （209.47 min ± 30.17 rain vs 174.33 min ± 30.29 min, 26 vs 15, P 〈 0.05）. Postoperative blood loss and postoperative complications were significantly lower in the observation group than in the control group （300.18 mL ± 50.29 mL vs 379.45 mL ± 50.49 mL, 6 vs 16, P 〈 0.05）. At I d after surgery, PT was prolonged and APTT was shortened in the observation group compared with preoperative value and that of the control group （PT： 12.94 s± 0.88 s vs 11.19 s ± 0.86 s, 11.75 s ± 0.90 s, P 〈 0.05; APTT： 26.28 s ± 2.54 s vs 30.23 s ± 2.68 s, 30.99 s ± 2.51 s, P 〈 0.05）. The DD contents at 1, 3, and 5 d after operation （1.77 s ± 0.23 s, 2.30 s ± 0.45 s, and 2.28 s ± 0.46 s, respectively） were significantly higher in the observation group compared with preoperative value （1.29 s± 4. 0.25 s） and those of the control group （1.49 s ±4. 0.26 s, 1.68 s ± 0.42 s, and 1.70 s ± 0.41 s, respectively）（P 〈 0.05）. The MA values at 1, 3, and 5 d after surgery in the observation group were higher than those of the control group （69.68 mm ± 6.48 mm vs 65.97 mm ± 6.15 mm, 70.51 mm ± 6.41 mm vs 67.02 mm ± 6.31 mm, 72.03 mm± 6.89 mm vs 69.60 mm ± 6.47 mm）. The ct values at 1, 3, and 5 d in the observation group （70.02 ± 4.33, 70.71 ± 4.47, and 73.08 ± 4.25, respectively） were significantly higher than preoperative value （60.20 ± 4.29） and those of the control group （65.69 ± 4.22, 67.48 ± 4.36, and 68.98 ± 4.51, respectively） （P 〈 0.05）. There was a significant difference in age, smoking status, ASA classification, tumor stage, and hypertension between DVT and non- DVT patients （P 〈 0.05）. CONCLUSION The incidence of DVT after laparoscopic surgery for gastrointestinal cancer surgery is higher than that after traditional laparotomy.