妇科腹腔镜术后患者下肢深静脉血栓形成的危险因素分析

Risk factors for postoperative lower extremity deep venous thrombosis formation in patients undergoing gynecologic laparoscopic surgery

目的探讨妇科腹腔镜手术患者术后下肢深静脉血栓(DVT)形成的危险因素。方法选择2017年1月—2019年5月在本院行妇科腹腔镜手术后发生DVT患者45例为观察组,术后未发生DVT患者45例为对照组。收集、统计入组患者临床资料,分析DVT形成危险因素。结果观察组年龄≥50岁、体质量指数(BMI)>24 kg/m^(2)、存在并发症、经腹手术、恶性疾病、术后卧床时间>5 d、手术时间>1 h、术前下肢超声异常、术中气腹压>15 mmHg、头高足低手术体位比例均高于对照组,差异有统计学意义(P<0.05);两组术中失血量比较,差异无统计学意义(P>0.05);年龄≥50岁、并发症、恶性疾病、术后卧床时间>5 d、术中气腹压>15 mmHg、头高足低手术体位是妇科腹腔镜手术后DVT形成的独立危险因素(OR值≥1且P<0.05)。结论年龄≥50岁、并发症、恶性疾病、术后卧床时间>5 d、术中气腹压>15 mmHg、头高足低手术体位是妇科腹腔镜手术后DVT形成的独立危险因素,临床应加以重视,及时实施防治措施,预防DVT形成。

Objective To investigate the risk factors of postoperative lower extremity deep venous thrombosis(DVT)in patients undergoing gynecologic laparoscopic surgery.Methods From January 2017 to May 2019,45 patients with lower extremity DVT in a hospital after gynecological laparoscopic surgery were selected as a research group,and 45 patients without DVT after the operation were selected as a control group.The clinical data of the patients enrolled werecollected and analyzed for the risk factors of DVT formation.Results In the research group,the age of the patients was≥50 years,the body mass index(BMI)was>24 kg/m^(2),there were comorbidities,and they had the history of transabdominal surgery,there were malignant diseases,the bed rest time was>5 days,the operation time was>1 hour,there were ultra-sound abnormalities in preoperative upper extremity,the intraoperative pneumoperitoneum pressure was>15 mm Hg,and theratio of head-high but foot-low operation position was higher than that in the control group,and the difference between thetwo groups was statistically significant(P<0.05).There was no significant difference between the two groups in the operationblooding volume(P>0.05).The independent risk factors for lower extremity DVT formation after the gynecologic laparoscopicsurgery included the age≥50 years,comorbidities,malignant diseases,postoperative bed rest time>5 days,intraoperative pneumoperitoneum pressure>15 mm Hg,and head-high and foot-low operation position(OR value≥1 and P<0.05).Conclusion The age≥50 years,comorbidities,malignant diseases,postoperative bed rest time>5 days,intraoperative pneumoperitoneum pressure>15 mm Hg,and head-high and foot-low operation position are the independent risk factors for lower extremity DVT formation after gynecologic laparoscopic surgery.Therefore,we should pay much attention to the preventive measures in time,so as to prevent the lower extremity formation of DVT.