腹壁疝患者围术期深静脉血栓形成的预防和治疗

Prevention and treatment of deep vein thrombosis during perioperative period in patients with abdominal wall hernia

深静脉血栓形成（DVT）是指血液在深静脉内异常凝结，阻塞静脉腔，导致静脉回流障碍的疾病，可见于全身主静脉，最常见于下肢。血栓形成后，若其发生脱落，还可引起肺动脉栓塞（PE）。PE和DVT是同种疾病在不同阶段的表现形式，两者统称为静脉血栓栓塞症（VTE）。本文汇集国内疝与腹壁外科领域5位专家，结合各自中心临床经验，从不同角度探讨腹壁疝手术患者围术期DVT的预防和治疗。刘子文教授介绍腹壁疝手术患者围术期DVT流行病学现状，强调其危险性，系统分析发生原因，主要包括静脉血流缓慢、静脉损伤、血液高凝状态、患者基础疾病及腹壁疝手术特有因素，着重阐述补片所致炎症反应诱发DVT的机制。张光永教授以清晰、缜密的临床思维翔实介绍其诊断要点，从临床表现到辅助检查手段，再到Wells量化评分，从一般到特殊，从定性到定量，层层递进和深入，力求做到早期、精准诊断，以免漏诊和轻视其危险程度。李航宇教授结合腹壁疝手术患者术前、术中及术后DVT危险因素，强调应在围术期不同时期、针对不同危险程度有的放矢，予相应预防和治疗措施。申英末教授分析腹腔镜腹壁疝手术诱发围术期DVT的特有因素，并指出：基于现有循证医学证据和相关指南，腹腔镜和开腹手术诱发围术期DVT的风险程度尚无定论，术者应综合评估和考量，个体化选择合适手术方式。陆朝阳教授介绍三大类主要治疗措施及其具体药物或方式、适应证、优弊、时机等，包括抗凝治疗、溶栓治疗及手术治疗，建议临床医师个体化、合理选用。

Deep vein thrombosis （DVT） refers to a venous reflux disorder caused by abnormal condensation of blood in deep veins. It is detected in cardinal veins of the whole body and often occurred in the lower extremities. Desquamation of thrombus may cause pulmonary embolism （PE）. PE and DVT are two clinical manifestations of different stages of the same disease, which are collectively referred to as venous thromboembolism （VTE）. Five famous experts in hernia and abdominal wall surgery explored the prevention and treatment of DVT during perioperative period in patients undergoing abdominal wall hernia surgery from different angles based on clinical experiences. Professor Liu Ziwen introduced the epidemiology of DVT during perioperative period in patients undergoing abdominal wall hernia surgery, emphasized its risks, analyzed systematically its mechanisms including slow venous blood flow, vein injury, high blood coagulation state, underlying diseases and specific factors of abdominal wall hernia surgery, focused on mechanisms of inflammation caused by meshes inducing DVT. Professor Zhang Guangyong introduced informatively its diagnosis with clear and careful thinking, from the clinical manifestations to assistant examinations and moreover to Wells quantitative scoring, from general to specific and from qualitative to quantitative, striving to achieve early and precise diagnosis in order to prevent misseddiagnosis or ignoration of its danger level. Professor Li Hangyu emphasized appropriate preventive and treatment measures according to different stages and risk levels by evaluating the risk factors of preoperative, intraoperative and postoperative DVT. Professor Shen Yingmo analyzed special factors of laparoscopic abdominal wall hernia inducing DVT during the perioperative period, and indicated that surgeons should select surgical methods individually after comprehensive evaluation and consideration because of uncertainty of risk degree in laparoscopic and open surgery inducing DVT during perioperative period based on existing evidencebased medicine and related guidelines. Professor Lu Chaoyang introduced three categories of main treatments including anticoagulation therapy, thrombolytic therapy and surgical therapy, and specific drugs, indications, advantages and disadvantages, opportunities, recommended clinicians to select individually and rationally.