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目的探讨妇科盆腔术后并发下肢深静脉血栓(DVT)的诊断治疗要点及预防措施。方法回顾性分析我院5例妇科DVT患者的临床特点及诊断、治疗和预防的方法。结果 5例临床有症状的可疑DVT患者,血浆D二聚体测定均大于500μg,通过彩色多普勒超声(彩超)确诊。确诊后采用尿激酶溶栓和肝素或低分子肝素抗凝及口服华法令等治疗,血栓完全溶解3例,部分溶解2例,症状均明显改善,无肺栓塞发生。结论通过彩色多普勒超声检查结合D二聚体升高及典型临床表现能明确诊断深静脉血栓,及时进行抗凝、溶栓治疗对DVT有较好疗效。术前纠正贫血,术中操作精细、减轻对髂静脉及其属支的刺激,术后鼓励患者早期下床活动是预防深静脉形成的主要方法;对有高危因素者术后可考虑预防性抗凝治疗。
Objective To investigate the diagnosis and treatment of pelvic deep venous thrombosis (DVT) after pelvic surgery and its preventive measures. Methods The clinical features, diagnosis, treatment and prevention of 5 gynecological DVT patients in our hospital were retrospectively analyzed. Results Five patients with clinically symptomatic suspicious DVT had plasma D dimer levels greater than 500 μg and were confirmed by color Doppler ultrasound. Confirmed after the use of urokinase thrombolysis and heparin or low molecular weight heparin anticoagulant and oral warfarin treatment, thrombosis completely dissolved in 3 cases, 2 cases of partial dissolution, the symptoms were significantly improved, no pulmonary embolism. Conclusion Color Doppler ultrasound combined with D-dimer elevation and typical clinical manifestations can be a clear diagnosis of deep venous thrombosis, timely anticoagulant and thrombolytic therapy for DVT has a good effect. Preoperative correction of anemia, intraoperative fine operation, reduce the stimulation of the iliac vein and its branches, to encourage patients to get out of bed early after surgery is the main method to prevent the formation of deep veins; for patients with high risk factors may consider prophylactic Condensation treatment.