直肠癌腹腔镜与开腹手术者凝血纤溶功能的影响

目的比较腹腔镜直肠癌手术与开腹手术对患者凝血纤溶功能的影响。方法将96例患者分为腹腔镜直肠癌手术组(腹腔镜组)50例及开腹手术组(开腹组)46例,分别于术前、术后1 h及术后24 h,用Clauss凝固法检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(FIB)、用血细胞分析仪进行血小板计数(PLT),用INR法计算凝血酶原国际标准化值(INR);用酶联免疫吸附双抗体夹心法(ELISA)定量测定血浆中D-二聚体(D-D)含量。结果术后1 h及术后24 h两组APTT、INR以及PLT较术前组差异无统计学意义;腹腔镜组FIB及D-D均显著升高,其差异有统计学意义(P<0.05),开腹组FIB术后1 h组虽升高,但其差异无统计学意义(P>0.05);D-D术后1 h及24 h升高差异有统计学意义,术后24 h两组明显增高,但组间差异有统计学意义。结论直肠癌腹腔镜手术及开腹手术均能使患者血液呈高凝状态,增加了术后血栓发生的风险,并且直肠癌腹腔镜手术对患者凝血功能的影响更大。

Comparative study of Laparoscopic surgery and laparotomy for rectal cancer on blood coagulation and fibrinolvsis

Objective To investigate the difference of laparoscopic surgery and laparotomy for rectal cancer on blood coagulation and fibrinolysis.Methods 96 patients were divided into laparoscopic gastric surgery group（laparoscopic group,50 cases） and abdominal surgery group（laparotomy group,46 cases）.Blood coagulation and fibrinolysis was determined by detecting the value of Clauss solidification monitoring prothrombin time test（PT）,activated partial thromboplastin time（APTT） and fibrinogen（FIB）.Platelet was counted with blood analyzers（PLT）,the prothrombin was calculated with International standardization of values（INR） and plasma D-dimer（D-D） was quantitatively determined using enzyme-linked immunosorbent assay method（ELISA） at pre-operation,1h and 24h hour after opration.Results 1h or 24h after operation,APTT INR and PLT did not have statistically significant changes,compared with the preoperative levels.In laparoscopic group,FIB and DD significantly increased（P〈0.05）.FIB in laparotomy group did not significantly increase after 1h,but D-D after 1 and 24h significantly increased.D-D in the two groups both significantly increased after 24h,but there was a significant difference between them.Conclusion Laparoscopic surgery and laparotomy may result in hypercoagulable state in patients with rectal cancer,thus increase the risk of thrombosis after surgery,colorectal laparoscopic surgery has a greater impact on blood coagulation compared with laparotomy.