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目的:了解腹腔镜和开腹手术后静脉血栓栓塞症(venous thromboembolism,VTE)的发生率及腹腔镜和开腹手术对外周血凝血功能的影响,初步探讨与开腹手术比较,腹腔镜手术是否更易增加血液高凝状态和VTE的发生。方法:收集我院2011年1月到2014年12月妇科、胃肠外科、肝胆外科、泌尿外科腹腔镜及开腹手术患者的临床资料,并对术后并发下肢深静脉血栓形成(deep vein thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE)患者的临床资料进行回顾性分析,比较腹腔镜及开腹手术患者手术前后凝血功能相关指标的改变情况。结果:1腹腔镜手术10 850例,术后并发VTE共27例,发生率0.25%,其中DVT 23例,发生率0.21%,PTE 6例,发生率0.06%;2开腹手术16 789例,术后并发VTE共31例,发生率0.18%,其中DVT 27例,发生率0.16%,PTE 6例,发生率0.04%;3腹腔镜及开腹手术后VTE、DVT、PTE的发生率分别比较均无统计学差异(P>0.05);4腹腔镜和开腹手术VTE患者术后的凝血酶原时间(prothrombin time,PT)明显延长,纤维蛋白原(fibrinogen,FIB)、纤维蛋白原降解产物(fibrinogen degration products,FDP)、D-二聚体(D-dimer,D-D)明显增高,与术前比较差异有统计学意义(P<0.05);腹腔镜和开腹手术VTE患者手术前后比较,其PT、FIB、FDP、D-D水平无明显统计学差异(P>0.05)。结论:与开腹手术相比,腹腔镜手术并没有显著性地增加术后血液高凝状态及VTE的发生率。
Objective: To investigate the incidence of venous thromboembolism (VTE) after laparoscopic and laparotomy and the effect of laparoscopy and laparotomy on the blood coagulation in peripheral blood. To investigate whether laparoscopic surgery Easier to increase the blood hypercoagulable state and the occurrence of VTE. Methods: The clinical data of patients with gynecology, gastrointestinal surgery, hepatobiliary surgery, urology laparoscopy and laparotomy from January 2011 to December 2014 in our hospital were collected. The clinical data of deep vein thrombosis , DVT) and pulmonary thromboembolism (PTE) were retrospectively analyzed. The changes of coagulation related indexes before and after laparoscopic and open surgery were compared. Results: 1 There were 10 850 cases of laparoscopic surgery and 27 cases of VTE after operation. The incidence of DVT was 0.25%, including 23 cases of DVT, incidence of 0.21%, 6 cases of PTE, incidence of 0.06%; 2 789 cases of laparotomy, There were 31 cases with VTE occurred after operation, the incidence rate was 0.18%. There were 27 cases of DVT, the incidence rate was 0.16%, PTE was 6 cases, the incidence rate was 0.04% .3 The incidence of VTE, DVT and PTE after laparoscopy and laparotomy were compared (P> 0.05). The prothrombin time (PT) in patients with VTE after laparoscopic and laparotomy was significantly prolonged, the fibrinogen (FIB), fibrinogen degradation products (FDP) and D-dimer (DD) in patients with VTE after laparoscopy and laparotomy were significantly higher than those before operation (P <0.05) The PT, FIB, FDP, DD levels were not significantly different (P> 0.05). CONCLUSIONS: Laparoscopic surgery did not significantly increase postoperative hypercoagulability and the incidence of VTE compared with open surgery.