目的 探討腹腔鏡手術(shù)圍手術(shù)期下肢深靜脈血栓形成(DVT)的相關(guān)危險因素。方法 回顧分析復(fù)旦大學(xué)華山醫(yī)院2007年3月至2008年1月期間收治的16例腹腔鏡術(shù)后DVT患者的臨床資料,并與同期148例腹腔鏡手術(shù)后無下肢DVT者的資料進(jìn)行比較,分析其相關(guān)危險因素。結(jié)果 手術(shù)時間>1 h者發(fā)生DVT的危險性是手術(shù)時間≤1 h者的4.15倍〔OR=4.15(95% CI: 1.36~12.68)〕,接受下腹部手術(shù)者發(fā)生DVT的危險性是接受中上腹部手術(shù)者的2.94倍〔OR=2.94(95% CI: 1.07~8.08)〕,高危者(高危因素≥3個)發(fā)生DVT的危險性是低危者(高危因素<3個)的3.94倍〔OR=3.94(95% CI: 1.38~11.23)〕。結(jié)論 腹腔鏡術(shù)后下肢DVT可能與手術(shù)時間長短、手術(shù)部位及術(shù)前高危因素的存在密切相關(guān)。圍手術(shù)期應(yīng)積極應(yīng)對、積極處理,預(yù)防其發(fā)生。
引用本文: 楊林,蔡端,祁光裕. 腹腔鏡術(shù)后下肢深靜脈血栓形成的相關(guān)因素分析. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(6): 425-428. doi: 復(fù)制
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22. | 王海波, 閆西紅, 高麗彩, 等. 低分子肝素鈣預(yù)防肥胖患者婦科腹腔鏡手術(shù)后深靜脈血栓形成的臨床研究 [J]. 中國內(nèi)鏡雜志, 2008; 14(3): 266-268. |
- 1. 張培華, 蔣米爾主編. 臨床血管外科學(xué) [M]. 第2版. 北京: 科學(xué)出版社, 2007: 568.
- 2. 馮力民, 夏恩蘭. 腹腔鏡術(shù)后深靜脈血栓的研究 [J]. 中國內(nèi)鏡雜志, 1999; 5(4): 20-22.
- 3. 張勇, 陳延山, 王義欣, 等. 腹腔鏡膽囊切除術(shù)后靜脈血栓12例分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5(11): 888-889.
- 4. 肖剛. 腹腔鏡術(shù)后下肢靜脈血栓28例分析 [J]. 腹腔鏡外科雜志, 2006; 11(6): 508-509.
- 5. Jorgensen JO, Hanel K, Lalak NJ, et al. Thromboembolic complications of laparoscopic cholecystectomy [J]. BMJ, 1993; 306(6876): 518-519.
- 6. Brown JA, Garlitz C, Gomella LG, et al. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy [J]. Urol Oncol, 2004; 22(2): 102-106.
- 7. 陳平康, 徐志成, 過建工, 等. 腹腔鏡膽囊切除術(shù)后下肢靜脈血栓形成 [J]. 生物醫(yī)學(xué)工程與臨床, 2001; 5(3): 157.
- 8. Patel MI, Hardman DT, Nicholls D, et al. The incidence of deep venous thrombosis after laparoscopic cholecystectomy [J]. Med J Aust, 1996; 164(11): 652-654, 656.
- 9. Milic DJ, Pejcic VD, Zivic SS, et al. Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy [J]. Surg Endosc, 2007; 21(9): 1588-1592.
- 10. Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan [J]. Ann Surg, 2005; 241(2): 208-216.
- 11. Maíllo CL, Martín E, López J, et al. Effect of pneumoperitoneum on venous hemodynamics during laparoscopic cholecystectomy. Influence of patients’ age and time of surgery [J]. Med Clin (Barc), 2003; 120(9): 330-334.
- 12. Fuchs S, Heyse T, Rudofsky G, et al. Continuous passive motion in the prevention of deep-vein thrombosis: a randomised comparison in trauma patients [J]. J Bone Joint Surg Br, 2005; 87(8): 1117-1122.
- 13. Okuda Y, Kitajima T, Egawa H, et al. A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy [J].Surg Endosc, 2002; 16(5): 781-784.
- 14. 王秋生, 張陽德譯. 內(nèi)鏡腹腔鏡外科學(xué) [M]. 北京: 中國醫(yī)藥科技出版社, 2001: 28.
- 15. 馬玉奎, 趙紀(jì)春, 胡志, 等, 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 56-58.
- 16. 胡大一, 孫藝紅. 血栓栓塞性疾病的規(guī)范防治——ACCP最新溶栓和抗栓指南的啟示 [J]. 臨床薈萃, 2005; 20(15):841-843.
- 17. Ginzburg E, Cohn SM, Lopez J, et al. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma [J]. Br J Surg, 2003; 90(11): 1338-1344.
- 18. Colditz GA, Tuden RL, Oster G. Rates of venous thrombosis after general surgery: combined results of randomised clinical trials [J]. Lancet, 1986; 2(8499): 143-146.
- 19. Flam E, Berry S, Coyle A, et al. Blood-flow augmentation of intermittent pneumatic compression systems used for prevention of deep vein thrombosis prior to surgery [J]. Am J Surg, 1996; 171(3): 312-315.
- 20. Schaepkens Van Riempst JT, Van Hee RH, Weyler JJ. Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin [J]. Surg Endosc, 2002; 16(1): 184-187.
- 21. 李友偉, 何平, 李生偉. 老年患者腹腔鏡膽囊切除術(shù)后下肢深靜脈血栓形成的預(yù)防 [J]. 臨床誤診誤治, 2008; 21(4):62-63.
- 22. 王海波, 閆西紅, 高麗彩, 等. 低分子肝素鈣預(yù)防肥胖患者婦科腹腔鏡手術(shù)后深靜脈血栓形成的臨床研究 [J]. 中國內(nèi)鏡雜志, 2008; 14(3): 266-268.