开腹与腹腔镜下全子宫切除术后患者凝血相关指标及炎性因子水平比较研究  

Changes of coagulation and inflammatory factors in hysterectomy patients treated with laparoscopic and open hysterectomy

作　　者：冯怡雯[1] 张艳梅[2] 陆惠芳[1] 田野[3] 鲍伟[1] 戴磊[1] 蔡逸婷[1] 吴昊[1] FENG Yi-wen;ZHANG Yan-mei;LU Hui-fang;TIAN Ye;BAO Wei;DAI Lei;CAI Yi-ting;WU Hao(Department of Obstetrics and Gynecology,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]上海市第一人民医院妇产科,上海200080 [2]新疆维吾尔自治区人民医院产科,新疆乌鲁木齐830001 [3]新疆医科大学第一附属医院血管甲状腺外科,新疆乌鲁木齐830054

出　　处：《临床军医杂志》2018年第8期894-896,共3页Clinical Journal of Medical Officers

基　　金：国家自然科学基金青年科学基金项目(81402134);上海市科委"科技创新行动计划"(16411954900)

摘　　要：目的比较开腹与腹腔镜下全子宫切除术后患者凝血相关指标和炎性因子水平。方法选取自2016年9月至2017年4月上海市第一人民医院收治的因患有子宫肌瘤、子宫肌腺症、宫颈重度上皮内瘤样病变等非恶性肿瘤而拟行开腹或腹腔镜下全子宫切除术的102例患者为研究对象,其中,48例行开腹全子宫切除术的患者纳入开腹组,54例行腹腔镜下全子宫切除术的患者纳入腹腔镜组。比较两组患者术前24 h和术后24 h的活化部分凝血酶原时间、凝血酶原时间、纤维蛋白原、D-二聚体、C反应蛋白及白细胞介素-6的表达水平。结果与术前比较,两组患者术后的活化部分凝血酶原时间、凝血酶原时间的表达水平降低,纤维蛋白原、D-二聚体、C反应蛋白及白细胞介素-6的表达水平升高,差异均有统计学意义(P<0.05);与开腹组比较,腹腔镜组患者术后24 h的纤维蛋白原、D-二聚体的表达水平升高,差异有统计学意义(P<0.05)。两组患者术后均未出现下肢深静脉血栓。结论开腹和腹腔镜下手术两种术式均会导致患者出现明显的炎症反应,患者术后处于血栓前状态,且腹腔镜下全子宫切除术更易发生血栓。Objective To investigate the effects and the differences of laparoscopic and open hysterectomy on coagulation and inflammation in patients. Methods All 102 patients without high risk factors in thrombosis were divided into two groups. Patients in Group A received laparoscopic hysterectomy and the cases in Group B with laparoscopic vaginal hysterectomy. Measuring the value of activated partial thromboplastin time（ APTT）,prothrombin time（ PT）,thrombin time（ TT）,fibrinogen（ FIB）,D-dimer,C-reactive protein（ CRP）,interleukin-6（ IL-6） respectively 24 hours before operation and 24 hours after operation. Results Compared with preoperation,APTT and PT were shortened after operation（ P〈0. 05）,and there was no significant difference between the two goups after operation（ P〈0. 05）. FIB and D-Dimer were significantly increased after operation. And the value of Group B was significantly higher than that of Group A（ P〈0. 05）. Twenty four hours after the operation,the levels of CRP and IL-6 in Group A were significantly increased（ P〈0. 05）,but there was no significant difference between the two groups（ P〈0. 05）. Conclusion Both of the two kinds of surgeries promote the obvious inflammatory reaction in patients. After the operation,the patients are in the prothrombotic state and laparoscopic hysterectomy is more likely to cause thrombosis.

关 键 词：开腹 腹腔镜 全子宫切除术 

分 类 号：R713[医药卫生—妇产科学]