妇科手术后深静脉血栓的预防和治疗进展

Prevention and treatment of deep venous thrombosis after gynecological surgery

静脉血栓栓塞(venous thromboembolism,VTE)是妇科手术后的并发症,主要包括深静脉血栓形成(deep venous thrombosis,DVT)以及肺血栓栓塞症(pulmonary thromboembolism,PTE)。DVT是指红细胞、血小板以及纤维蛋白在静脉内形成血栓,并阻塞静脉回流进而造成静脉壁的炎性改变。当DVT的血栓脱落,随血液运行至肺部则形成PTE。由于DVT以及PTE是静脉血栓栓塞疾病过程中的两个阶段,因此预防DVT对于防止PTE这种起病急骤且病死率极高的术后并发症非常重要。由于手术后妇女的激素水平、血液浓度以及血脂代谢紊乱等机体内环境变化较大,及易诱发VTE,一旦阻塞肺部血管,将威胁患者生命。为寻找预防妇科术后静脉栓塞有效、简便的方法,该文对目前妇科手术后深静脉血栓的预防和治疗进展作一综述。

Venous thromboembolism(VTE)is one of the common complications after gynecological surgery.VTE mainly includes deep venous thrombosis(DVT)and pulmonary thromboembolism(PTE).DVT is caused by the thrombogenesis of red blood cells,platelets and fibrous protein which obstructs the venous backflow leading to inflammatory changes in the wall of the vein.PTE is caused by the caducous blood clots of DVT that runs with the blood to the lungs.Because DVT and PTE are the venous thromboembolic disease process in two stages,the prevention of DVT and PTE is very important for preventing the rapid onset of PTE and high mortality rate of the postoperative complications.The changes of female hormones and the blood concentration and lipid metabolism disorders make venous thromboembolism more likely to occur during pregnancy.Once the pulmonary vessels were blocked,the patients′life would be threatened severely.To find a more effective way to prevent postoperative venous thrombosis in gynecology,we review the prevention and treatment of deep venous thrombosis after gynecological surgery in this paper.