腹腔镜与开腹全子宫切除术对术后深静脉血栓形成影响的对照研究

目的：探讨腹腔镜与开腹子宫切除术对患者凝血、纤溶系统及术后深静脉血栓形成（deep vein thrombosis,DVT）的影响。方法：将65例良性疾病行子宫切除术的患者非随机分为两组,32例行腹腔镜子宫切除术（腹腔镜组）,33例行开腹子宫切除术（开腹组）,分别于术前、术后即刻、术后24 h及术后48 h抽取静脉血检测凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FG）及D二聚体（D-D）等指标,观察各指标的变化及术后深静脉血栓发生率。结果：术后即刻及术后24 h两组患者APTT较术前明显降低,差异有统计学意义（P〈0.05）;各时点PT、TT较术前无明显变化（P〉0.05）。两组患者术后即刻D-D值明显升高,与术前相比差异有统计学意义（P〈0.05）;术后24 h、48 h进一步升高,与术后即刻相比差异有统计学意义（P〈0.05）。术后即刻、术后24 h两组患者FG均升高,与术前相比差异有统计学意义（P〈0.05）。两组间各指标相比差异无统计学意义（P〉0.05）。两组术后DVT发生率无明显差异（P〉0.05）。结论：腹腔镜与开腹子宫切除术均可使患者血液呈高凝状态,增加了术后血栓的发生风险;对于血栓高危因素的患者术后需常规采取预防措施。因腹腔镜手术住院时间短,术后应密切随访与指导。

Control study about influence of laparoscopic and open hysterectomy on postoperative deep venous thrombosis

Objective ： To investigate the influence of laparoscopic surgery and laparotomy for hysterectomy on blood coagulation and fibrinolytic system, prevention and treatment of the postoperative deep vein thrombosis （DVT）. Methods ：Sixty-five patients of be- nign uterine disease who underwent hysterectomy were nonrandomly divided into laparoscopic hysterectomy group （32 cases） and open hysterectomy group （33 cases）. The values of tYF, APTT,TF, FG and D-D before operation,postoperative 0 h and 24 h and 48 h and in- cidence of postoperative DVT were detected respectively. Results：Compared with preoperative data,the APTT of postoperative 0 h and 24 h were significantly lower （P 〈 0.05） ;There was no change in the values of PT and TT at the time of postoperative 0 h,24 h and 48 h. Compared with the preoperative value,the D-D value of postoperative 0 h increased significantly （P 〈 0.05 ） , compared with the postoperative 0 h,the D-D value of postoperative 24 h and 48 h increased further （ P 〈 0.05 ） ; Compared with preoperative level, the value of FG in postoperative 0 h and 24 h increased significantly （ P 〈 0.05 ）. The parameters between the two groups had no statistical differences （ P 〉 0.05 ）. The incidence of postoperative DVT was similar between the two groups （ P 〉 0.05 ）. Conclusions ： Both lapa- roseopie and open hysterectomy could make the patients at high blood coagulation state,increase the risk of postoperative DVT. Routine preventive measures should be taken for high-risk factors of thrombosis, the discharge time of laparoscopic surgery is earlier, so an- tithrombotic therapy guidance and close follow-up are suggested.