妇科盆腔手术后下肢深静脉血栓形成的临床研究  

Prospective investigation of postoperative lower extremity deep venous thrombosis in gynecological procedures

作　　者：刘玉珍[1] 张震宇[1] 郭淑丽[1] 何文[1] 张晓蓉[1] 王淑珍[1] 刘崇东[1] 李金凤[1] 李琳[1] 

机构地区：[1]首都医科大学附属北京朝阳医院妇产科

出　　处：《中华妇产科杂志》2006年第2期107-110,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨妇科盆腔手术后下肢深静脉血栓(LEDVT)的发生率、高危因素及早期诊断方法。方法前瞻性比较141例妇科盆腔手术患者LEDVT的发生率、发病特点、高危因素、诊断方法及凝血功能变化,分别于术前1周、术后48h及术后5～7d检测患者血小板计数、凝血酶原时间、活化的部分凝血活酶时间、纤维蛋白原、凝血酶时间、D二聚体、抗凝血酶Ⅲ、组织型纤溶酶原活化物、纤溶酶原活化物抑制剂水平,并行双下肢静脉超声检查。结果(1)术后发生LEDVT22例(血栓组),发生率为15.6%,发生时间为术后2～7d,平均(4.1±1.2)d;术后未发生LEDVT119例(非血栓组)。(2)发生LEDVT的高危因素是术后开始床上活动时间晚、术后常规应用止血药、合并心血管疾病、淋巴清扫术、年龄、全身麻醉、恶性肿瘤等,但多因素分析显示,年龄及术后应用止血药是LEDVT发生的独立影响因素。(3)血栓组术后D二聚体平均为(0.9±0.6)mg/L,非血栓组为(0.5±0.4)mg/L,两组比较,差异有统计学意义(P<0.01);D二聚体用于预测LEDVT的阳性预测值为31.0%,阴性预测值为98.6%;手术后较手术前抗凝血酶Ⅲ有所升高。(4)22例行静脉超声诊断的血栓患者中,有4例行双下肢静脉造影,结果均与超声诊断相符。(5)两组手术前后组织型纤溶酶原活化物、纤溶酶原活化物抑制剂等水平比较,差异无统计学意义(P>0.05)。结论妇科盆腔手术后LEDVT的发生率较高,D二聚体、抗凝血酶Ⅲ水平检测结合静脉超声检查,可作为LEDVT的早期筛查手段。建议对有LEDVT高危因素的患者,手术后2～7d常规筛查静脉血栓,争取早发现、早治疗。Objective To investigate the morbidity, relevant factors and diagnostic methods of lower extremity deep venous thrombosis （LEDVT） after gynecological pelvic surgeries. Methods A prospective study was carried out investigating the morbidity, characteristics, risk factors, the coagulation function changes and diagnostic methods of LEDVT post-gynecological pelvic operations in 141 cases. Platelet, prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, D-dimer, antithrombin-Ⅲ, tissue plasminogen activator, plasminogen activator inhibitor were measured within 1 week before surgeries, 48 hours and 5 - 7 days post-surgeries respectively. Color Doppler flow imaging was performed simultaneously. Results （ 1 ） Twenty-two cases were found with LEDVT, the morbidity of LEDVT after gynecological procedures was 15.6%. It occurred 2 - 7 days post operation. （2） The risk factors were bedfasting, coagulant prescription post-operation, cardiovascular disease, ageing, pelvic lymphadenectomy, general anesthesia, and malignancy. Multivariate regression showed only age and coagulant prescription post-operation were independent factors. （3） The level of D-dimer was （ 0. 9 ±0. 6） mg/L in LEDVT group, significantly higher than that of non-LEDVT group[ （0. 5 ± 0. 4） mg/L, P 〈 0. 01 ]. The positive predictive value and negative predictive value of D-dimer were 30. 8% and 98.6% respectively. （4） Among 22 cases who were diagnosed with LEDVT by compression duplex ultrasound, only 4 cases performed lower extremity venography, and the diagnosis was confirmed. Conclusions The morbidity of postoperative lower extremity deep venous thrombosis in gynecological procedures was high. The combination of D-dimer and compression duplex ultrasound examination was applicable to the diagnosis of LEDVT. The optional duration of the examination was 2-7 days post operations.

关 键 词：静脉血栓形成 腿 妇外科手术 手术后并发症 

分 类 号：R713[医药卫生—妇产科学]