妇科腹腔镜手术后下肢深静脉血栓形成的临床分析

目的:探讨妇科腹腔镜手术后患者下肢深静脉血栓形成的机制与高危因素,总结临床诊治及预防措施。方法:选择2009年3月至2011年12月38例妇科盆腔手术术后发生下肢深静脉血栓的患者作为研究对象,同时选择同期未发生下肢深静脉血栓的200例患者作为对照,回顾分析其临床资料,总结形成下肢深静脉血栓的机制与高危因素,以及诊断、治疗、预防措施。结果:患者均采用血管多普勒超声进行诊断,确诊后立即行抗凝治疗,35例患者血栓全部溶解,3例患者血栓部分溶解。经过2~4周的治疗,患者临床症状明显改善,均未出现肺栓塞症状,病情好转后出院。其中高龄、伴内科合并症、CO2气腹患者术后下肢深静脉血栓发生率相对较高,差异有统计学意义(P<0.05)。术后随访3个月,无病情恶化、复发。结论:加强妇科腹腔镜手术后患者下肢深静脉血栓的预防,科学合理应用抗凝、溶栓等措施,对于术前合并高血压、高血脂、糖尿病等血液高凝状态的患者,术后严密监测,可有效降低下肢深静脉血栓的发生率,减轻患者痛苦,有效提高生存质量。

Clinical analysis of lower extremity deep vein thrombosis after gynecological laparoscopic surgery

Objective：To investigate the mechanisms and risk factors related to lower extremity deep vein thrombosis （DVT） after gynecological laparoscopic surgery and summarize the diagnosis, treatment and prevention. Methods：Thirty-eight patients who developed DVT after laparoscopic pelvic gynecological surgery from Mar. 2009 to Dec. 2011 were included as study group. Another 200 contemporaneous patients without DVT were included as control group. The clinical data of all these patients were retrospectively analyzed. The mechanisms and risk factors of DVT formation, diagnosis, treatment and prevention were explored and summarized. Results： All DVT patients were diagnosed by ultrasound and received anticoagulant therapy immediately. Of all 38 patients,35 patients＇ DVT totally dissolved and 3 patients＇ DVT partly dissolved. After 2-4 weeks＇ treatment, patients were discharged and clinical syndromes significantly improved without pulmonary embolism. Elder patients, patients with medical complications or CO2 pneumoperitoneum had a higher rate of DVT （P 〈 0.05 ）. No recurrence or exacerbation was observed after 3 months postoperative follow-up. Conclusions ： Prevention of DVT after gynecological laparoscopic surgery should be strengthened. Scientific application of anticoagulants and thrombolytic drugs, close monitoring of blood hypercoagulable state of patients with hypertension, hyperlipidemia and diabetes can effectively reduce DVT,alleviate patients＇ pain and improve life quality.