腹腔镜胆道术后下肢深静脉血栓形成的防治

目的探讨腹腔镜胆道术后下肢深静脉血栓形成（DVT）的原因及其治疗。方法回顾性分析我院1999年10月-2007年10月收治的腹腔镜胆道术后发生下肢DVT的45例临床资料。本组采用抗凝、溶栓治疗35例．深静脉插管溶栓治疗8例，手术取栓2例。结果全组病例治疗后症状均有不同程度好转。结论腹腔镜胆道手术病人是术后下肢深静脉血栓形成（DVT）的高危人群，围手术期的积极预防及早发现，早治疗可取得较好疗效。     

腹腔镜术后下肢深静脉血栓形成危险因素的临床分析

探讨腹腔镜手术围手术期术后下肢深静脉血栓形成(DVT)的相关危险因素,并分析D-二聚体浓度变化与下肢DVT的关系。232例腹腔镜(腹部外科)手术患者232例,记录发生下肢DVT的病例,分析患者年龄、手术时间、性别以及手术体位对下肢DVT的影响。术后发生下肢DVT5例记为血栓组,未发生下肢DVT 227例为非血栓组,采用免疫比浊法定量测定两组患者术前、术后第1天、术后第3天血浆D-二聚体浓度的变化,并分析其浓度变化与DVT形成的关系。结果显示,年龄≥40岁、手术时间≥2 h、术后下床活动时间≥30 h、头高脚低位为腔镜手术患者术后DVT形成的危险因素(P=0.006,0.013,0.019,0.000),性别对下肢DVT无明显影响(P=0.683)。术前血栓组和非血栓组血浆D-二聚体浓度无明显差异(P=0.991),血栓组5例术后第1天、术后第3天D-二聚体浓度均0.5μg/m L,与术前和非血栓组差异有统计学意义(P=0.000)。结果表明,年龄≥40岁、手术时间≥2 h、术后下床活动时间≥30 h、头高脚低位为腹腔镜手术患者术后下肢DVT的危险因素,而术后D-二聚体明显升高(0.5μg/m L)与下肢DVT有关。     

妇产科手术后并发下肢深静脉血栓防治护理体会

目的探讨妇产科手术后并发下肢深静脉血栓(deep venous thrombosis,DVT)的护理方法。方法对50例接受妇产科手术的患者,给予预防下肢DVT形成的护理,观察术后下肢DVT形成率及护理满意度。结果本组术后下肢DVT形成率4.00%,患者护理满意度100%。结论对妇科手术后患者行针对性下肢DVT形成的护理措施,可减少术后下肢DVT形成,提高患者护理满意度。     

腹腔镜术后下肢深静脉血栓形成的相关因素分析

目的 探讨腹腔镜手术围手术期下肢深静脉血栓形成(DVT)的相关危险因素.方法 回顾分析复旦大学华山医院2007年3月至2008年1月期间收治的16例腹腔镜术后DVT患者的临床资料,并与同期148例腹腔镜手术后无下肢DVT者的资料进行比较,分析其相关危险因素.结果 手术时间>1 h者发生DVT的危险性是手术时间≤1 h者的4.15倍[OR=4.15(95%CI:1.36～12.68)],接受下腹部手术者发生DVT的危险性是接受中上腹部手术者的2.94倍[OR=2.94(95%CI:1.07～8.08)],高危者(高危因素≥3个)发生DVT的危险性是低危者(高危因素<3个)的3.94倍[OR=3.94(95%CI:1.38～11.23)].结论 腹腔镜术后下肢DVT可能与手术时间长短、手术部位及术前高危因素的存在密切相关.围手术期应积极应对、积极处理,预防其发生.     

腹腔镜术后下肢深静脉血栓形成的诊治分析

目的 探讨腹腔镜围手术期下肢深静脉血栓形成(DVT)的原因、高危因素及诊治措施.方法 回顾性分析本院2005年3月至2007年1月收治的12例腹腔镜术后深静脉血栓病例的临床资料.结果 腹腔镜术后深静脉血栓占同期收治血栓患者7.3%(12/164),均经溶栓抗凝对症治疗后症状消失,4例放置下腔静脉滤器,无肺栓塞发生.随访3～15个月,无复发.结论 腹腔镜围手术期体位、麻醉等应激状态及患者高危因素均可导致下肢深静脉血栓形成,甚至肺栓塞.围手术期应积极应对,仔细观察处理高危因素,预防深静脉血栓形成.     

子宫切除术后下肢深静脉血栓形成的危险因素及手术方式影响的研究

目的探索子宫切除术后下肢深静脉血栓形成(DVT)的发病率、风险因素,以及不同手术方式对术后下肢DVT的影响。方法回顾性分析上海同济大学附属医院2001年1月1日至2016年11月30日行子宫切除术患者的临床资料。对比分析发生与未发生术后下肢DVT患者的相关数据,利用双变量分析探讨术后DVT相关的危险因素。并进一步分析经腹入路、腹腔镜以及经阴道入路3种术式对子宫切除术后DVT的影响。结果术后DVT的发病率为2%(220/10248)。术后下肢DVT的发生与体重指数(BMI)、经腹子宫切除术、妇科恶性肿瘤、手术时间和术后卧床时间密切相关(P0.05);子宫切除术后下肢DVT在经腹入路相较非经腹入路的似然比为2.69,95%可信区间为1.46~4.95;但腹腔镜术后下肢DVT患者中漂浮型血栓比率(67%)较经腹开放术后下肢DVT患者(29%)显著增高。结论BMI、经腹子宫切除术、手术时间、妇科恶性肿瘤和术后卧床时间是子宫切除术后下肢DVT的危险因素。腹腔镜手术较开放手术术后下肢DVT发生率低,但更需要早期预防降低肺梗塞发生的风险。     

血栓弹力图指导预防腹腔镜结直肠肿瘤患者术后下肢深静脉血栓形成的应用研究

目的:探讨血栓弹力图指导预防腹腔镜结直肠手术患者术后下肢深静脉血栓形成(LDVT)的综合干预措施,以降低DVT发生率。方法:收集2018年1月至2018年12月接受腹腔镜结直肠手术的100例患者,术后患者返回病房后即采用VTE风险因素评估表(Caprini评分);评分≥2分的中高危DVT患者,进一步采用TEG监测,并采取主动与被动物理干预措施,采取下肢压力梯度治疗仪及不同的物理运动治疗,包括踝关节背伸、跖屈活动、双下肢足泵运动,床上活动使用卧床患者功能锻炼器进行,同时予以适当的药物干预。结果:与干预前相比,干预后48 h、1周、2周,患者TEG参数R值、MA值改善差异有统计学意义(P<0.05);高凝患者数量减少(P<0.05)。干预后2周,仅1例患者发生下肢深静脉血栓,发生率为1.02%。结论:采用血栓弹力图联合Caprini评分系统对腹腔镜结直肠手术后患者LDVT筛查具有积极的指导作用,采取积极有效的综合护理及药物干预措施,可有效改善凝血功能、降低术后下肢深静脉血栓的发生。     

骨折术后并发下肢深静脉血栓形成的原因分析和预防方法

目的探讨骨折术后下肢深静脉血栓形成(deep venous thrombos,DVT)的原因与预防。方法对18例骨折术后患者出现下肢深静脉血栓的临床资料进行回顾性分析。结果创伤、手术、疼痛、肢体固定、全身病变是下肢深静脉血栓形成的重要原因。结论骨科医疗工作者应该充分认识到骨科病人DVT的高危性,积极的采取各种有效的措施来预防下肢深静脉血栓的形成。     

间歇式充气加压装置预防腹腔镜结直癌术后下肢深静脉血栓形成的观察

目的探讨腹腔镜下结直肠癌手术后下肢静脉血栓形成(DVT)的原因及机制,总结临床诊疗方法及预防措施。方法前瞻性分析广东药科大学附属第一医院2010年8月至2016年6月行腹腔镜结直肠癌手术患者共128例,将患者随机分为研究组(50例)及对照组(78例),研究组腹腔镜结直肠癌术后予以机械性预防措施(间歇式充气加压装置,IPC),对照组术后无预防措施。对比分析两组下肢DVT的发生率、凝血功能变化、术后并发症等。结果腹腔镜下结直肠癌术后,研究组发生1例下肢DVT,对照组发生6例,发生率为7.69%。结论腹腔镜结直肠癌术后发生下肢DVT与多种因素有关,对于腹腔镜患者采取积极的机械性干预措施可减少下肢DVT发生率,减少患者术后并发症。     

低分子肝素钙预防腹腔镜术后下肢深静脉血栓形成的作用

目的探讨术前单次使用低分子肝素钙预防腹腔镜术后下肢深静脉血栓形成(DVT)的作用。方法使用前瞻性随机对照方法,将腹腔镜手术患者随机分成2组,研究组(A组)术前0.5 h皮下注射5 000μg低分子肝素钙,再行手术。对照组(B组)行常规腔镜手术。对比2组的下肢深静脉血栓的发生率、凝血功能变化、术后相关并发症及住院时间等。结果 A组的血栓率为0.5%,B组的血栓率为6.0%,比较差异有统计学意义(P<0.05)。2组在术中出血量、凝血四项及血小板计数变化、住院时间等均无差异(P>0.1)。A组术后肝素相关并发症多为皮肤过敏,无出血并发症。结论腹腔镜胆囊切除术前使用单次低分子肝素钙对预防下肢深静脉血栓形成疗效明显,对术中术后出血无明显影响,安全、简便,具有一定临床应用价值。     

Incidence of Lower Limbs Deep Vein Thrombosis After Open and Laparoscopic Gastric Bypass: A Prospective Study

Background Lower limbs deep vein thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality and are even higher in bariatric patients. The longer operative time and higher immobility in these patients increase the DVT risk. Although deaths after bariatric surgery have been reported, there is no consensus regarding the prophylaxis of DVT. This study’s objective is to determine the incidence of lower limbs DVT in patients submitted to Roux-en-Y-gastric bypass (RYGBP) under prophylaxis by enoxaparin. Methods Patients with body mass index (BMI) equal to or higher than 35 kg/m² who submitted to RYGBP by laparotomy or laparoscopy using 40 mg/day of enoxaparin for 15 days were recruited between October 2004 and August 2005. Individuals with previous DVT and heparin allergy were excluded. Patients were tested for DVT using color Doppler ultrasound performed before surgery and on the second and fifth weeks after surgery. Results The study population included 136 patients, with 126 concluding the protocol. There were 79% (100/126) of female patients aged 19 to 65 years old, with mean of 40 years SD = 10 and BMI between 35 and 61 kg/m², mean of 43 kg/m² (SD = 5). All patients who submitted to RYGBP were divided as 55% (69/126) by laparoscopy and 45% (57/126) by laparotomy. The incidence rate of lower limbs DVT was 0.79% (1/126). Conclusion The low incidence rate of DVT found in our study suggests that obesity might not be a major risk factor for venous thromboembolism in patients submitted to RYGBP.     

The blood F VIII:Ag/F VIII:C ratio as an early indicator of deep venous thrombosis during post-traumatic immobilization

Twenty-two consecutive patients with spinal fractures (eight with spinal cord injuries) were studied. All patients were immobilized in bed for 6 weeks after trauma. The occurrence of deep venous thrombosis (DVT) was detected by the 125I-labeled fibrinogen test and confirmed by venography. F VIII:C, F VIII:Ag, and AT III activities were determined 2, 6, and 10 to 12 days after trauma. All paralyzed patients (n = 8) developed DVT and two of them had pulmonary embolism within 5 days after trauma. F VIII:Ag and F VIII:C disproportionally increased and the values of F VIII:Ag/F VIII:C ratio above 2 predicted DVT. AT III remained normal during the whole immobilization time and the values of DVT(+) and DVT(-) groups were comparable.     

The occurrence of the post-thrombotic changes after an acute deep venous thrombosis. A prospective two-year follow-up study

BACKGROUND: The aim of the study is to investigate the development of subjective and objective findings during the first two years after DVT (deep venous thrombosis). METHODS: This prospective two-year follow-up study was established in Tampere University Hospital in Finland. Twenty-six patients with a two-year follow-up after a phlebographically confirmed DVT were followed. Patients were treated conventionally with heparin and warfarin. Phlebography was repeated 7 months after DVT. Color-flow duplex imaging (CFDI) was performed in both legs 7 and 20 months after DVT. The subjective symptoms in both legs were recorded at the beginning and at the end of the follow-up. The development of venous reflux, obstruction and subjective symptoms after DVT were studied. RESULTS: 50% of the legs with DVT had a pathological (deep reflux or obstructive change) CFDI-finding in the popliteal segment after a 20-month follow-up. The pathological findings in the control legs were rare. The rate of recanalisation was high. There was no difference between calf and more proximal DVTs. Pain (62%), oedema (46%) and pigmentation (35%) were common and only 27% of the legs with DVT were asymptomatic. CONCLUSIONS: The development of the post-thrombotic syndrome begins quite early. The frequency of the subjective symptoms is high. Calf DVT may lead to postthrombotic sequelae in the popliteal segment.     

人工全髋关节置换术后下肢深静脉血栓形成的多因素分析

目的:分析影响人工全髋关节置换术(THA)后下肢深静脉血栓形成(DVT)的危险因素。方法:对98例(112个关节)人工全髋置换术术后DVT发生情况进行分析。其中男55例,女43例;平均年龄59.12岁(41～81岁)。术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生。对17项临床因素与人工关节置换术后DVT形成的相关性进行了分析。结果:术后发生DVT41例,DVT发生率为41.84%(41/98),其中无症状DVT患者占58.54%(24/41)。经Logistic多因素回归分析,与DVT相关的因素有5个,其中年龄、肥胖及肢体延长大于2cm使术后发生DVT的风险分别增加到1.952、3.349及7.376倍(P<0.05);硬膜外麻醉和踝泵练习使术后发生DVT的可能性减少到原来的0.132和0.265(P<0.01)。结论:年龄、肥胖及肢体延长大于2cm是人工关节置换术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习是减少术后发生DVT的保护因素。关节置换术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞。     

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目的　探讨二维彩色多普勒超声显像 (CDFI)对下肢深静脉血栓形成 (DVT)的诊断价值。方法　1998～ 2 0 0 3年对 97例下肢DVT病人进行CDFI检查 ,了解病肢深静脉的管壁、管径、血栓位置、大小、范围、静脉瓣功能及静脉血流情况。结果　 97例 (98条 )下肢DVT病例中 ,伴有下肢深静脉瓣功能不全者 6例。其中 ,中央型 2 1条 (2 1 4 2 % ) ,周围型 4 6条 (4 6 94 % ) ,全肢型 31条 (31 6 4 % )。病肢左右侧之比为 3 3:1(P <0 0 0 1)。结论　CDFI在下肢DVT方面具有特异性表现 ,可以成为下肢DVT诊断、预后判断和随访的首选方法。     

Incidence of deep vein thrombosis after varicose vein surgery

BACKGROUND: Varicose vein surgery is generally considered to have little risk of postoperative deep vein thrombosis (DVT). This prospective study examined the incidence of DVT in patients undergoing varicose vein surgery. METHODS: Lower leg veins were assessed before operation by duplex ultrasonography in 377 patients, and reassessed 2-4 weeks after surgery, and again at 6 and 12 months. Patients were instructed to contact a physician if symptoms consistent with DVT occurred before the scheduled follow-up appointment. Preoperative prophylaxis (a single dose of subcutaneous heparin) was left to the discretion of the vascular surgeon. RESULTS: DVT was detected in 20 (5.3 per cent) of the 377 patients. Of these, only eight were symptomatic and no patient developed symptoms consistent with pulmonary embolus. Eighteen of the 20 DVTs were confined to the calf veins. Subcutaneous heparin did not alter the outcome. No propagation of thrombus was observed and half of the DVTs had resolved without deep venous reflux at 1 year. CONCLUSION: The incidence of DVT following varicose vein surgery was higher than previously thought, but these DVTs had minimal short- or long-term clinical significance.     

Evolution of deep venous thrombosis: a 2-year follow-up using duplex ultrasound scan and strain-gauge plethysmography

OBJECTIVE: The development of the post-thrombotic syndrome (PTS) and recurrence of deep venous thrombosis (DVT) are not yet fully understood. The aim of the study was to identify factors that lead to the long-term complications of DVT. METHODS: In a 2-year prospective follow-up study, duplex scanning and strain-gauge plethysmography were used to evaluate DVT in relation to the development of long-term complications. Each of the 12 segments examined was assigned as a thrombosis score (TS). A total TS was calculated for each leg. Patent segments were assigned a TS = 0, noncompressible vein segments with flow TS = 1 and noncompressible vein segments without flow TS = 2. The degree of resolution of DVT and the incidence, timing, and outcome of further thrombotic events were measured during 24 months of follow-up. RESULTS: The study involved 86 legs with DVT. The 2-year follow-up was completed for 70 legs. Within 3 months, only 1% of the originally occluded proximal deep vein segments were still occluded. Between all time intervals, from month 12 to month 24, for example, thrombus regression continued in 36% of the legs and thrombus propagation continued in 27%. Multiple regression analysis revealed that an increase in age (P = .008) and proximal location of the original DVT (P = .05) was significantly related to thrombus propagation. Multiple regression analysis showed that the risk factors for clinical signs of PTS were a high venous outflow resistance after 1-month and 12-month follow-ups (P 相似文献   

全髋关节置换术后深静脉血栓形成

目的：探讨全髋关节置换术后下肢深静脉血栓形成（DVT）的发生情况及预防治疗措施。方法：对220例（244髋）全髋关节置换患者围手术期皮下注射低分子肝素来预防治疗下肢深静脉血栓形成。术后第7天行彩色多普勒超声检查。结果：58例发生下肢深静脉血栓，其中远端血栓33例，近端血栓14例，全静脉血栓11例，DVT发生率26．4％，未发生1例肺栓塞。结论：围手术期低分子肝素应用可降低全髋关节置换术后DVT发生率，且安全可靠。     

下肢术后深静脉血栓形成的风险因素分析

目的：研究骨科下肢术后深静脉血栓的发生率并进行风险因素分析。方法：1999年11月至2002年5月未行预防性抗凝治疗的下肢手术患者136例，男78例，女58例；年龄16-82岁，平均49．5岁。术前行双下肢超声多普勒检查排除深静脉血栓，术后行双侧上行性静脉造影检查，并分析可能相关的风险因素。结果：关节置换术后发生深静脉血栓共24例，其中全髋置换术后10例，全膝置换术后14例。骨性关节炎、类风湿性关节炎、股骨头无菌性坏死及股骨颈骨折术后发生深静脉血栓分别为9、6、7和12例。结论：研究发现高龄、深静脉血栓既往史、合并心血管疾病、糖尿病及骨水泥、止血带的使用对深静脉血栓的形成都有较大影响。