腹腔镜手术联合腹腔热灌注化疗对结直肠癌患者术后凝血指标的影响

Effects of laparoscopic surgery combined with hyperthermic intraperitoneal chemotherapy on postoperative coagulation indicators in patients with colorectal cancer

目的观察结直肠癌(CRC)患者腹腔镜手术后进行腹腔热灌注化疗(HIPEC)治疗后凝血功能的变化。方法选取2023年1月至10月重庆市开州区人民医院收治的60例CRC患者作为研究对象,随机分为研究组和对照组,各30例。对照组采用腹腔镜手术,研究组采用腹腔镜手术联合HIPEC(氟尿嘧啶)。观察比较两组患者手术情况及围术期凝血功能指标的变化。结果研究组和对照组患者术中出血量[(84.33±40.66)mL vs(100.33±52.82)mL]、手术时间[(174.77±31.29)min vs(167.67±28.61)min]、肛门排气时间[(3.17±0.79)d vs(3.03±0.81)d]及术后住院时间[(14.23±3.76)d vs(14.70±5.34)d]比较,差异无统计学意义(P>0.05)。两组患者组内凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D二聚体(D-D)水平随着时间点推移有显著变化(P<0.05),而两组组间上述指标比较差异无统计学意义(P>0.05)。两组患者术后腹腔出血、深静脉血栓、肠梗阻及吻合口瘘等并发症总发生率比较,差异无统计学意义(20.00%vs 13.33%,χ^(2)=0.481,P=0.488)。结论尽管腹腔镜手术导致结直肠癌患者凝血功能增强,血液处于高凝状态,但其术后联合HIPEC并不增加术后深静脉血栓形成风险,故HIPEC仍安全可靠。

Objective To observe the changes of coagulation function in patients with colorectal cancer(CRC)after laparoscopic surgery combined with hyperthermic intraperitoneal chemotherapy(HIPEC).Methods Sixty patients with CRC admitted to The People s Hospital of Kaizhou District,CQ from January to October 2023 were selected as the study subjects and randomly divided into study group and control group,with 30 cases in each group.The control group underwent laparoscopic surgery,while the study group underwent laparoscopic surgery combined with HIPEC(fluorouracil).The surgical conditions and changes in perioperative coagulation function indicators were observed and compared between two groups.Results There was no statistically significant difference between the study group and the control group in intraoperative blood loss[(84.33±40.66)mL vs(100.33±52.82)mL],surgical time[(174.77±31.29)min vs(167.67±28.61)min],anal exhaust time[(3.17±0.79)d vs(3.03±0.81)d],and postoperative hospital stay[(14.23±3.76)d vs(14.70±5.34)d](P>0.05).The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D)in the two groups showed significant fluctuations over time(P<0.05),while there was no significant difference in the above indicators between the two groups(P>0.05).There was no statistically significant difference in the total incidence of postoperative compliaticons(20.00%vs 13.33%,χ^(2)=0.481,P=0.488)such as abdominal bleeding,deep vein thrombosis,intestinal obstruction,and anastomotic fistula between the two groups.Conclusion Although laparoscopic surgery leads to enhanced coagulation function and hypercoagulable blood in patients with CRC,the combination of postoperative HIPEC does not increase the risk of postoperative deep vein thrombosis,therefore,HIPEC technology is still safe and reliable.