摘要
目的 比较研究腹腔镜胆囊切除术和开腹胆囊切除术后的血液凝固状态的改变。方法 检测41例腹腔镜胆囊切除术(LC)和 19例开腹胆囊切除术(OC)患者术后24 h血液凝血酶原时间(PT)、部分凝血活酶时间(APTT)、抗凝血酶Ⅲ活性(AT-Ⅲ:A)、血管性血友病因子(VWF)、纤维蛋白原(FIB)、Ⅷ因子活性(Ⅷ:C)、D-二聚体(D-D)、纤溶酶原(PLG)。两组的入选标准均为缓解期的胆囊结石和胆囊息肉,既往无导致血栓形成的高危因素,选择OC者为经济条件不佳或对腹腔镜技术心存疑虑者;LC组手术时间为30～165 min,平均(63.5±36.1)min;OC组手术时间为35～100 min,平均(64.5±19.1)min,差异无统计学意义(P>0.05)。采用SPSS 10的软件包对LC和OC的上述血凝指标进行独立样本的t检验。结果 术后24 h两组PT、APTT、AT-Ⅲ:A均值在正常范围,组间比较差异无统计学意义(P>0.05);俩组VWF、D-D、Ⅷ;C均值均明显超出正常范围,但组间比较差异无统计学意义(P>0.05)。术后两组PLG均值在正常范围,但LC组比OC组高,组间比较差异有统计学意义(P<0.05)。结论 腹腔镜技术能引起血液的高凝状态,但与传统的剖腹手术相比,并无更严重的改变,也无更高的深静脉血栓形成的危险性。
Objective To study the changes of homeostasis after laparoscopic cholecystectomy versus open cholecystectomy. Methods Forty-one patients with laparoscopic cholecystectomy and 19 patients with open cholecystectomy were enrolled in this study. The homeostasis parameters including PT, APTT, ATⅢ; A, VWF, FIB, Ⅶ: C, D-D, PLG were measured at 24 hours after operation. The criteria of selection were the cholelithiasis and polyps patients without complication and high risks of thrornboembolic diseases or previous history. In case of patients with financial difficulty or lack of confidence on laparoscopic technique, open cholecystectomy was the selection. Mean operation time was 63. 5±36. 1 minutes( range, 30 -165 minutes) in LC, and 64. 5 ± 19. 1 minutes (range, 35 -100 minutes) in OC. Statistical analysis was done with SPSS 10' s two-sided t-test for paired samples. Results The mean values of PT, APTT, and AT-ⅢA were normal and the mean values of VWF, D-D, Ⅷ; C were significantly increased in both LC and OC groups without significant difference (P > 0. 05 ). The mean values of PLG were normal but those of LC were higher than OC with significant difference ( P < 0. 05). Conclusion These results indicate that laparoscopic technique may lead to plasma hyper-coagulation but in compare with the traditional laparotomy there was no difference in plasma coagulation and risk of DVT.
出处
《中华消化内镜杂志》
2003年第6期392-394,共3页
Chinese Journal of Digestive Endoscopy
