腹腔镜及开腹手术对原发性肝癌术后下肢深静脉血栓形成的影响

The impacts of laparoscopic surgery and laparotomy on the incidence of lower extremity deep venous thrombosis in patients with primary hepatocellular carcinoma after operation

目的观察腹腔镜和开腹手术对肝癌手术患者术后下肢深静脉血栓(DVT)形成的影响及探索术毕血栓弹力图(TEG)及凝血功能相关参数对患者术后DVT发生的预测效能。方法选取2016年8月至2019年6月本院收治的120例肝癌患者作为研究对象,按随机数字表法分为腹腔镜手术组和开腹手术组,每组60例。比较患者手术前后血栓弹力图(TEG)参数(R值、K值、α角和MA值)、凝血功能参数[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶凝固时间(TT)、D-二聚体(D-D)]的变化。统计两组患者术后7 d内DVT发生率及分析两组患者术后住院时间及并发症的总发生率的差异。结果两组患者手术前后TT值、R值及K值相比较,差异均无统计学意义(均P>0.05)。与术前相比,两组患者术后1、3、7 d DD值、α角和MA值均更高,且与腹腔镜手术组同时间点相比,开腹手术组术后1、3、7 d DD值、α角和MA值均更低(均P<0.05)。两组患者手术后DVT发生率及并发症总发生率比较差异均无统计学意义(均P>0.05),但腹腔镜手术组住院时间明显更低(P<0.01)。将术后患者按是否发生DVT进行重新分组,与DVT组相比较,非DVT组术后1 dα值、MA值及DD均明显更低(均P<0.05)。受试者工作特征(ROC)曲线分析显示仅α角的的ROC曲线下面积(AUC)大于0.7。结论肝癌患者接受两种手术方式后下肢DVT的发生率没有显著差异,TEG的α值对于肝癌肿瘤患者术后7 d内DVT的发生具有中等效能的预测效果。

Objective To observe the impacts of laparoscopic surgery and laparotomy on the incidence of lower extremity deep venous thrombosis(DVT)in patients with primary hepatocellular carcinoma(HCC)after operation,and to explore the predictive effect of thrombelastogram(TEG)and coagulation parameters on the occurrence of DVT after operation.Methods From August 2016 to June 2019,120 patients with HCC in our hospital were selected and they were divided into laparoscopic operation group and laparotomy group by the random number table method,with 60 cases in each group.The changes of thrombelastogram(TEG)parameters(such as:R value,K value,alpha angle,and MA value)and coagulation function parameters[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin coagulation time(TT),D-dimer(D-D)]were compared before and after operation.The incidence of DVT within 7 days after operation in the two groups was counted,and the differences of the hospitalization time and the total incidence of complications between the two groups were analyzed.Results There were no statistically significant differences in TT,R,and K values between the two groups before and after surgery(P>0.05).Compared with the same group before operation,the DD,alpha angle,and MA values in each group were higher at 1,3,and 7 days after operation,and the DD,alpha angle,and MA values in the laparoscopic operation group were higher at 1,3,and 7 days after operation than those in the laparotomy group at the same time points(P<0.05).There were no statistically significant differences in the incidence of DVT and the total incidence of complications between the two groups(P>0.05),but the hospitalization time of the laparoscopic operation group was significantly lower(P<0.01).The postoperative patients were regrouped according to whether DVT occurred.Compared with the DVT group,theαvalue,MA value,and DD were significantly lower in the non-DVT group at 1 day after operation(P<0.05).The receiver operating characteristic curve analysis showed that only the area under curve of alpha angle was greater than 0.7.Conclusion There is no statistically significant difference in the incidence of DVT in lower extremities between patients with HCC receiving two surgical methods.The alpha angle of TEG has a moderate predictive effect on the occurrence of DVT in patients with HCC within 7 days after operation.