腹腔镜胃癌手术与开腹手术对患者凝血功能影响的对比研究

目的观察、对比胃癌腹腔镜手术与开腹手术对患者凝血功能的影响。方法腹腔镜胃癌手术(腔镜组)及开腹手术(开腹组)患者各35例分别于手术前、手术结束及术后24h,采用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),采用INR法计算凝血酶原国际标准化值(INR);采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)的含量。结果腔镜组和开腹组手术结束及术后24hAPTT及INR较术前无显著差异,而FIB及D-D于手术结束及术后24h均显著升高,且两组间差异有统计学意义,两组PT于术后24h亦明显降低,但组间无显著差异。结论腹腔镜胃癌手术及开腹手术均可使患者血液呈高凝状态,增加术后血栓发生的风险,且腹腔镜胃癌对患者凝血功能的影响更大,应在围术期积极采取预防措施。

Comparative Analysis between Laparoscopic Surgery and Laparotomy for Gastric Cancer on Coagulation

Objective To investigate the difference between laparoscopic surgery and laparotomy for gastric cancer on blood coagulation. Methods Blood coagulation was determined by detecting the values of the PT, APTT, FIB and INR, and enzyme linked immunosorbent assay (ELISA) was used to detect the value of DD before operation, 24th hour after operation in 35 patients under laparoscopic surgery or laparotomy for gastric cancer respectively. Results Compared with pre-operation, no change in the values of APTT and INR at the end of operation and 24th hour post-operation could be observed in both two groups. The values of FIB and DD markedly increased at the end of operation and 24th hour post-operation in both two groups, and there were significant difference between two groups (P<0.05). The values of PT decreased at 24th hour post-operation sharply in two groups, but there were no significant difference. Conclusion The effect of laparoscopic surgery appeared to make coagulation strata vary more significantly than laparotomy operation, which would increase the incidence of deep vein thrombosis. So it is requisite to perform the treatment of anti-coagulation on the patients with laparoscopic surgery.