腹腔镜肝血管瘤切除术后深静脉血栓形成的危险因素分析  

Analysis of the risk factors of deep venous thrombosis after laparoscopic resection of hepatic hemangioma

作　　者：关碧[1] 李玉英[1] 敖永琼[1] 代义春 侯艳玲[1] 冯惠[1] GUAN Bi;LI Yu-ying;AO Yong-qiong;DAI Yi-chun;HOU Yan-ling;FENG Hui(Department of Surgery,Chengdu Fifth People's Hospital,Chengdu 611130,China)

机构地区：[1]成都市第五人民医院外科

出　　处：《中国医学前沿杂志（电子版）》2019年第5期98-101,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的分析影响腹腔镜肝血管瘤切除术后深静脉血栓形成(deep venous thrombosis,DVT)的危险因素。方法回顾性分析2015年1月至2018年1月于本院行腹腔镜肝血管瘤切除术的186例患者的临床资料,将术后发生DVT的21例患者纳入DVT组,术后未发生DVT的165例患者纳入非DVT组。比较两组患者性别、年龄、体质指数(body mass index,BMI)≥ 25kg/m2患者占比、合并高血压患者占比、合并糖尿病患者占比、病灶位置、手术时间、术中肝血流阻断时间、术中失血量、术后血小板计数、术后白细胞计数、有肝切除史患者占比、肝切除量、术后第3天D-二聚体(D-dimer,D-D)水平、术后第7天血清丙氨酸转氨酶(alanine aminotransferase,ALT)水平、住ICU天数、术后住院天数的差异,经Logistic回归分析筛选影响腹腔镜肝血管瘤切除术后DVT的独立危险因素。结果两组患者年龄、BMI ≥ 25 kg/m2患者占比、合并高血压患者占比、合并糖尿病患者占比、手术时间、术中肝血流阻断时间、术中失血量、术后血小板计数、肝切除量、术后第3天D-D水平、住ICU天数、术后住院天数、术后第7天血清ALT水平比较差异均具有显著差异(P均< 0.05);Logistic回归分析显示:术中肝血流阻断时间> 14.39 min、术中失血量≥ 1000 ml、肝切除量≥ 35%、术后第3天D-D水平≥ 0.5 μg/ml、术后第7天血清ALT水平> 231.42 U/L均为影响腹腔镜肝血管瘤切除术后出现DVT的独立危险因素(P均< 0.05)。结论术中肝血流阻断时间> 14.39 min、术中失血量≥ 1000 ml、肝切除量≥ 35%、术后第3天D-D水平≥ 0.5 μg/ml、术后第7天血清ALT水平>231.42 U/L的腹腔镜肝血管瘤切除术后患者出现DVT的风险相对较高,重视上述情况并及时予以低分子肝素等预防措施对降低DVT发生风险有一定帮助。Objective To analyze the risk factors of deep venous thrombosis (DVT) after laparoscopic resection of hepatic hemangioma. Method The clinical data of 186 patients who underwent laparoscopic resection of hepatic hemangioma in our hospital from January 2015 to January 2018 were analyzed retrospectively, and 21 patients with DVT after operation were included in DVT group, and 165 patients without DVT after operation were included in non-DVT group. Gender, age, proportion of patients with body mass index (BMI)≥ 25 kg/m2, proportion of patients with hypertension, proportion of patients with diabetes mellitus, location of focus, operation time, intraoperative hepatic blood flow blocking time, intraoperative blood loss, postoperative platelet count, postoperative leukocyte count, proportion of patients with history of hepatectomy, hepatectomy volume, D-dimer (D-D) level on the 3rd day after operation, serum alanine aminotransferase (ALT) level on the 7th day after operation, ICU stay and postoperative hospital stay were compared between the two groups. Logistic regression analysis was used to screen out independent risk factors for DVT after laparoscopic resection of hepatic hemangioma. Result There were significant differences in age, proportion of patients with BMI ≥ 25 kg/m2, proportion of patients with hypertension, proportion of patients with diabetes mellitus, operation time, intraoperative hepatic blood flow blocking time, intraoperative blood loss, postoperative platelet count, hepatectomy volume, D-D level on the 3rd day after operation, ICU stay and postoperative hospital stay and serum ALT level on the 7th day after operation between the two groups (Pall < 0.05). Logistic regression analysis showed that intraoperative hepatic blood flow blocking time > 14.39 min, intraoperative blood loss ≥ 1000 ml, hepatectomy volume ≥ 35%, D-D level ≥ 0.5 μg/ml on the 3rd day after operation and serum ALT level > 231.42 U/L on the 7th day after operation were the independent risk factor for DVT after laparoscopic

关 键 词：腹腔镜肝血管瘤切除术 深静脉血栓形成 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]