腹腔镜与开腹结直肠癌根治术对凝血、纤维蛋白溶解指标及下肢深静脉血栓形成的影响  

Effect of laparoscopic and laparotomy radical resection of colorectal cancer on coagulation, fibrinolysis and lower extremity deep venous thrombosis

作　　者：韩磊[1] 武雪亮[1] 薛军[1] 屈明[1] 郭飞[1] 孙弟波 马力丰[2] 郝剑[1] 章燕 Han Lei;Wu Xueliang;Xue Jun;Qu Ming;Guo Fei;Sun Dibo;Ma Lifeng;Hao Jian;Zhang Yan(Department of Vascular Glandular Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Ultrasound,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of General Surgery,Wanquan District Hospital of Traditional Chinese Medicine,Zhangjiakou 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院血管腺体外科,河北张家口075000 [2]河北北方学院附属第一医院超声医学科,河北张家口075000 [3]张家口市万全区中医院普通外科,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2022年第2期142-147,共6页Journal of Vascular and Endovascular Surgery

基　　金：河北省2018年度医学科学研究课题计划(20180876)。

摘　　要：目的 探讨腹腔镜与开腹结直肠癌根治术对凝血、纤维蛋白溶解指标及下肢深静脉血栓形成(LEDVT)的影响。方法 收集2017年6月至2019年5月河北北方学院附属第一医院收治的122例结直肠癌患者的临床资料,按照手术方法不同将患者分为腹腔镜组(n=62,行腹腔镜结直肠癌根治术)和开腹组(n=60,行开腹手术)。比较两组患者术前3 d及术后1、3 d的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fib)水平、D-二聚体(D-D)水平及血栓弹力图(TEG)参数。术前1 d及术后1、3、7 d行下肢静脉多普勒超声检查,确定有无LEDVT。结果 术后1、3 d,腹腔镜组患者的APTT均短于开腹组患者,差异均有统计学意义(P<0.05)。术后1 d,腹腔镜组患者的PT、TT均长于开腹组患者,差异均有统计学意义(P<0.05)。开腹组患者术后1、3d的Fib水平均高于腹腔镜组患者,术后1d的D-D水平高于腹腔镜组患者,差异均有统计学意义(P<0.05)。术后1、3 d,腹腔镜组患者的α角和MA值均低于开腹组患者,差异均有统计学意义(P<0.05)。两组患者术后LEDVT的发生情况比较,差异无统计学意义(P>0.05)。结论 腹腔镜与开腹结直肠癌根治术均会对结直肠癌患者的凝血、纤溶功能造成影响,均存在导致术后发生LEDVT的风险,但腹腔镜结直肠癌根治术对患者凝血功能的影响较开腹手术小,且不会提高LEDVT的发生率。Objective To investigate the effect of laparoscopic and laparotomy radical resection of colorectal cancer on coagulation, fibrinolysis and lower extremity deep venous thromaosis(LEDVT). Method The clinical data of 122 patients with colorectal cancer treated in the First Affiliated Hospital of Hebei North University from June 2017 to May 2019 were collected. According to different surgical methods, the patients were divided into laparoscopy group(n=62, laparoscopic radical resection of colorectal cancer) and laparotomy group(n=60, laparotomy). The activated partial thromboplastin time(APTT), prothrombin time(PT), thrombin time(TT), fibrinogen(Fib), D-dimer(D-D) levels and thromboelastogram(TEG) parameters of the two groups were compared 3 days before operation and 1, 3 days after operation. Doppler ultrasonography of lower extremity vein was performed 1 day before operation and 1, 3, 7 days after operation to determine whether there was deep venous thrombosis of lower extremity. Result At 1 and 3 days after operation, APTT in laparoscopy group was shorter than that in laparotomy group, and the difference was statistically significant(P<0.05). One day after operation, PT and TT in the laparoscopy group were longer than those in the laparotomy group, and the difference was statistically significant(P<0.05). The Fib level in the laparotomy group was higher than that in the laparoscopy group at 1 and 3 days after operation, and the D-D level at 1 day after operation was higher than that in the laparoscopy group(P<0.05). At 1 and 3 days after operation, the α angle and MA value in the laparoscopy group were lower than those in the laparotomy group(P<0.05). There was no significant difference in the incidence of LEDVT between the two groups(P>0.05). Conclusion Both laparoscopic and laparotomy radical resection of colorectal cancer will affect the coagulation and fibrinolysis function of patients with colorectal cancer, and there is a risk of postoperative LEDVT. However, laparoscopic radical resection of colorectal can

关 键 词：结直肠癌 下肢 深静脉血栓形成 血栓弹力图 腹腔镜手术 开腹手术 

分 类 号：R543[医药卫生—心血管疾病]