腹腔镜脾切除术围手术期凝血功能变化的临床研究  

Clinical study of the coagulation function change during perioperative period of laparoscopic splenectomy

作　　者：陈柏庆[1] 王跃东[2] 

机构地区：[1]绍兴文理学院附属医院,浙江绍兴312000 [2]浙江大学医学院附属第二医院

出　　处：《腹腔镜外科杂志》2015年第8期561-564,共4页Journal of Laparoscopic Surgery

摘　　要：目的:观察腹腔镜脾切除术(laparoscopic splenectomy,LS)与开腹脾切除术(open splenectomy,OS)患者围手术期凝血功能的变化,对比两种手术方式对人体的影响,探讨其发生机制。方法:回顾分析62例行脾切除术患者的临床资料,其中32例行LS,30例行OS,取5个时间点:术前1 h、术后1 h、24 h、48 h、72 h,分别检测患者的血常规(PLT)及凝血谱(PT、APTT、TT、FIB、D-dimer、AT-Ⅲ:A),所得结果进行组内与组间比较。结果:PLT两组术后组内均有明显变化。PT值LS组术后均延长,而OS组缩短。APTT值LS组术后缩短(P<0.05),OS组术后缩短不明显,组间相比差异无统计学意义(P>0.05)。TT值两组术后变化不明显,组内比较差异无统计学意义(P>0.05),但术后24 h两组差异有统计学意义(P<0.05)。两组FIB含量术后均明显升高,但FIB组间比较差异无统计学意义(P>0.05)。两组AT-Ⅲ:A术后均下降,且OS组下降更明显,组内及组间比较差异有统计学意义(P<0.05)。结论:LS与OS后均出现血液凝固系统功能增强,抗凝系统作用下降,血液均处于一定的高凝状态,需预防术后门静脉系统血栓的形成。Objective： To examine the changes of coagulation and fibrinolysis system before and after laparoscopic splenectomy（ LS） and open splenectomy（ OS）,compare the influence of the two surgery methods on blood coagulation in human body and probe the possible mechanism. Methods： Sixty-two patients hospitalized at the same time in the second affiliated hospital,zhejiang university school of medicine were selected,32 patients underwent LS and 30 underwent OS. The results within each group and between groups were compared,platelet（ PLT）,prothrombin time（ PT）,activated partial thromplastin time（ APTT）,thrombin time（ TT）,fibrinogen（ FIB）,antithrombin Ⅲ activity（ AT-Ⅲ： A） and D-dimer（ D-D） levels were measured at 1 h preoperatively,1 h,24 h,48 h and 72 h postoperatively. Results： There was significant difference in PLT levels after LS and OS（ P〈0. 05）. PT levels prolonged within 1 h,24 h,48 h and 72 h after LS,while it shortened after OS,there was significant difference compared within groups and between groups（ P〈0. 05）. APTT shortened 1 h,24 h and 48 h after LS,there was significant difference compared within groups（ P〈0. 05）,while there was no significant difference in these levels compared between groups（ P〈0. 05）. TT levels remained stable after surgery,and there was no significant difference in these levels within groups（ P〈0. 05）,but there was significant difference between groups,the level of24 h after LS was more than after OS（ P〈0. 05）. FIB levels increased after LS and OS,there was significant difference in these levels within groups（ P〈0. 05）,while there was no significant difference in these levels between groups（ P〈0. 05）. D-D levels increased in both groups,there was significant difference within groups（ P〈0. 05）,but the levels were significantly higher after OS than after LS within 1 h,24 h and 48 h（ P〈0. 05）. AT-Ⅲ： A level was significantly less after LS and OS,there was significant difference withi

关 键 词：脾切除术 腹腔镜检查 血液凝固 

分 类 号：R657.6[医药卫生—外科学]