腹腔鏡膽囊切除術(shù)對(duì)凝血系統(tǒng)的影響
發(fā)布時(shí)間：2019-03-24 15:15
【摘要】：目的：目前國(guó)內(nèi)外對(duì)于手術(shù)后下肢靜脈血栓形成(DVT)的研究逐漸增多,但腹腔鏡膽囊切除后出現(xiàn)(DVT)的并發(fā)癥的文獻(xiàn)報(bào)道并不多,深靜脈血栓的形成是一個(gè)潛在的致死致殘的并發(fā)癥,在肝膽、婦產(chǎn)、胃及泌尿外科等開展腹腔鏡手術(shù)的疾病都有術(shù)后發(fā)生深靜脈血栓的報(bào)道,但發(fā)生率各家報(bào)道差異較大,基于此,本研究探討腹腔鏡膽囊切除術(shù)對(duì)患者凝血系統(tǒng)的影響。方法：選取2014年03月至2014年08月在包頭醫(yī)學(xué)院一附院普外科行膽囊切除術(shù)的住院患者75例為研究對(duì)象,將該組患者按照手術(shù)方式的不同分為開腹膽囊切除術(shù)患者31例(開腹組)和腹腔鏡膽囊切除術(shù)患者44例(腹腔鏡組),所有患者于術(shù)前1天、手術(shù)后24小時(shí)術(shù)后72小時(shí)抽靜脈血檢測(cè)血小板計(jì)數(shù)(PLT),凝血酶原時(shí)間(PT),部分凝血酶原時(shí)間(APTT),凝血酶時(shí)間(TT),纖維蛋白原(FIB), D-二聚體(DD),并于術(shù)后3天行下肢血管彩超。各時(shí)間點(diǎn)抽取的樣品,經(jīng)過預(yù)處理后送檢驗(yàn)科,用ELISA(酶聯(lián)免疫吸附試驗(yàn))檢測(cè)D-Dimer、FIB、TT、PLT、APTT及PT的值和術(shù)后3天下肢靜脈彩超結(jié)果并記錄。比較兩組患者的手術(shù)療效、凝血系統(tǒng)相關(guān)指標(biāo)、下肢深靜脈血栓的形成情況以及出院前的生活質(zhì)量。采用SPSS 15.0軟件,計(jì)量資料用(x±s)表示,如凝血指標(biāo)、手術(shù)時(shí)間、疼痛評(píng)分等指標(biāo)采用兩獨(dú)立樣本t檢驗(yàn)比較,計(jì)數(shù)資料采用百分比表示,如術(shù)后并發(fā)癥、膽管損傷率等采用卡方檢驗(yàn),檢驗(yàn)水準(zhǔn)α=0.05,以P0.05認(rèn)為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果：兩組的手術(shù)成功率無統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后肛門排氣時(shí)間、腸鳴音恢復(fù)時(shí)間、住院時(shí)間少于對(duì)照組,膽總管損傷率、術(shù)后疼痛評(píng)分、腸粘連率低于對(duì)照組,有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)前24h的凝血系統(tǒng)指標(biāo)血小板計(jì)數(shù)(PLT),凝血酶原時(shí)間(PT),部分凝血酶原時(shí)間(APTT),凝血酶時(shí)間(TT),纖維蛋白原(FIB),D-二聚體(DD)均無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后24h的PLT、PT、APTT、TT、FIB、DD之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后72h的PLT、PT、APTT、TT、FIB、DD之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)后下肢靜脈血栓的發(fā)生率無統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組出院前在角色受限、軀體疼痛、總體健康、生命活力等方面的生活質(zhì)量高于對(duì)照組,有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論腹腔鏡膽囊切除術(shù)的手術(shù)療效好于傳統(tǒng)開放性手術(shù),具有創(chuàng)傷小、術(shù)后出血少、恢復(fù)快、并發(fā)癥少等優(yōu)點(diǎn),且氣腹與體位的共同作用未顯著增加對(duì)患者血凝狀態(tài)影響,能夠顯著提高患者術(shù)后的生活質(zhì)量,是一種值得推廣的手術(shù)方式。
[Abstract]:Objective: at present, there are more and more studies on (DVT) of lower extremity venous thrombosis after laparoscopic cholecystectomy, but there are few reports about the complications of (DVT) after laparoscopic cholecystectomy. The formation of deep venous thrombosis (DVT) is a potentially fatal and disabling complication. Deep venous thrombosis (DVT) has been reported in hepatobiliary, gynecological, gastric and urological diseases after laparoscopic surgery, but the incidence of DVT varies greatly from one country to another. The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on coagulation system in patients. Methods: from March 2014 to August 2014, 75 inpatients who underwent cholecystectomy in the General surgery Department of the first affiliated Hospital of Baotou Medical College were selected as subjects. The patients were divided into open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44) according to different operation methods. All patients were on the first day before the operation, and all the patients were divided into two groups: open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44). Platelet count (PLT), prothrombin time (PT), partial prothrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD), 24 hours after operation and 72 hours after operation The blood vessels of the lower extremities were examined by color Doppler ultrasonography on the 3rd day after operation. The samples were pre-treated and sent to the laboratory. The values of D, B, T, PLT, APTT and PT were detected by enzyme-linked immunosorbent assay (ELISA), and the results of color Doppler ultrasonography of lower limb vein were recorded 3 days after operation. The results of operation, coagulation system, deep venous thrombosis (DVT) and quality of life (QOL) before discharge were compared between the two groups. Using SPSS 15.0 software, the measurement data were expressed by (x 鹵s), such as coagulation index, operation time, pain score and other indexes were compared by two independent sample t-test, the counting data were expressed as percentage, such as postoperative complications. The chi-square test was used to test the bile duct injury rate, 偽 = 0.05, the difference was statistically significant (P0.05). Results: there was no significant difference in the success rate of operation between the two groups (P0.05). The operative time, intraoperative bleeding, postoperative anal exhaust time, recovery time of intestinal sound, hospitalization time, common bile duct injury rate, postoperative pain score and intestinal adhesion rate in the observation group were lower than those in the control group, and the postoperative pain score and intestinal adhesion rate were lower in the observation group than in the control group. There was statistical significance (P0.05). Platelet count (PLT), prothrombin time (PT), partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD) had no statistical significance (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 24 hours after operation (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 72 hours after operation (P0.05). There was no significant difference in the incidence of lower extremity venous thrombosis between the two groups (P0.05). Before discharge, the quality of life in the observation group was significantly higher than that in the control group in role limitation, body pain, overall health and vitality (P0.05). Conclusion Laparoscopic cholecystectomy has the advantages of less trauma, less bleeding, faster recovery and less complications than traditional open cholecystectomy, and the combined action of pneumoperitoneum and body position has no significant effect on the hemagglutination status of the patients. Can significantly improve the quality of life of patients after surgery, is a worthy of promotion of surgery.
【學(xué)位授予單位】：內(nèi)蒙古大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.4
本文編號(hào)：2446437
[Abstract]:Objective: at present, there are more and more studies on (DVT) of lower extremity venous thrombosis after laparoscopic cholecystectomy, but there are few reports about the complications of (DVT) after laparoscopic cholecystectomy. The formation of deep venous thrombosis (DVT) is a potentially fatal and disabling complication. Deep venous thrombosis (DVT) has been reported in hepatobiliary, gynecological, gastric and urological diseases after laparoscopic surgery, but the incidence of DVT varies greatly from one country to another. The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on coagulation system in patients. Methods: from March 2014 to August 2014, 75 inpatients who underwent cholecystectomy in the General surgery Department of the first affiliated Hospital of Baotou Medical College were selected as subjects. The patients were divided into open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44) according to different operation methods. All patients were on the first day before the operation, and all the patients were divided into two groups: open cholecystectomy group (n = 31) and laparoscopic cholecystectomy group (n = 44). Platelet count (PLT), prothrombin time (PT), partial prothrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD), 24 hours after operation and 72 hours after operation The blood vessels of the lower extremities were examined by color Doppler ultrasonography on the 3rd day after operation. The samples were pre-treated and sent to the laboratory. The values of D, B, T, PLT, APTT and PT were detected by enzyme-linked immunosorbent assay (ELISA), and the results of color Doppler ultrasonography of lower limb vein were recorded 3 days after operation. The results of operation, coagulation system, deep venous thrombosis (DVT) and quality of life (QOL) before discharge were compared between the two groups. Using SPSS 15.0 software, the measurement data were expressed by (x 鹵s), such as coagulation index, operation time, pain score and other indexes were compared by two independent sample t-test, the counting data were expressed as percentage, such as postoperative complications. The chi-square test was used to test the bile duct injury rate, 偽 = 0.05, the difference was statistically significant (P0.05). Results: there was no significant difference in the success rate of operation between the two groups (P0.05). The operative time, intraoperative bleeding, postoperative anal exhaust time, recovery time of intestinal sound, hospitalization time, common bile duct injury rate, postoperative pain score and intestinal adhesion rate in the observation group were lower than those in the control group, and the postoperative pain score and intestinal adhesion rate were lower in the observation group than in the control group. There was statistical significance (P0.05). Platelet count (PLT), prothrombin time (PT), partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (DD) had no statistical significance (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 24 hours after operation (P0.05). There was no significant difference in PLT,PT,APTT,TT,FIB,DD between the two groups 72 hours after operation (P0.05). There was no significant difference in the incidence of lower extremity venous thrombosis between the two groups (P0.05). Before discharge, the quality of life in the observation group was significantly higher than that in the control group in role limitation, body pain, overall health and vitality (P0.05). Conclusion Laparoscopic cholecystectomy has the advantages of less trauma, less bleeding, faster recovery and less complications than traditional open cholecystectomy, and the combined action of pneumoperitoneum and body position has no significant effect on the hemagglutination status of the patients. Can significantly improve the quality of life of patients after surgery, is a worthy of promotion of surgery.
【學(xué)位授予單位】：內(nèi)蒙古大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 支永發(fā);;腹腔鏡膽囊切除術(shù)對(duì)高原紅細(xì)胞增多癥患者下肢深靜脈血栓形成的預(yù)防[J];高原醫(yī)學(xué)雜志;2008年01期
2 張英;;高原環(huán)境血紅蛋白變化的若干研究[J];高原醫(yī)學(xué)雜志;2008年02期
3 高軍林;;西寧地區(qū)腹腔鏡膽囊切除術(shù)特點(diǎn)的臨床分析——附3000例報(bào)告[J];高原醫(yī)學(xué)雜志;2009年01期
4 黃韜;羅彪;劉佳;杜景平;;高原地區(qū)和非高原地區(qū)腹腔鏡膽囊切除術(shù)的比較[J];華西醫(yī)學(xué);2011年10期
5 陳偉;;腹腔鏡術(shù)后深部靜脈血栓形成的研究進(jìn)展[J];中國(guó)交通醫(yī)學(xué)雜志;2006年02期
6 管軍華;;單孔無氣腹腹腔鏡對(duì)婦科手術(shù)凝血功能的影響[J];中國(guó)臨床醫(yī)學(xué);2009年02期
7 陸朋云;梁偉;朱志強(qiáng);姚寒暉;張善家;;直腸癌腹腔鏡與開腹手術(shù)者凝血纖溶功能的影響[J];中國(guó)臨床保健雜志;2010年06期
8 張建國(guó);劉濤;趙威威;;有無氣腹腔鏡下膽囊切除術(shù)對(duì)機(jī)體凝血及纖溶影響的對(duì)比觀察[J];內(nèi)蒙古醫(yī)學(xué)雜志;2013年11期
9 趙至成;王福利;仲小舟;趙澤文;朱家曙;王磊;蒙禧增;楊劍;;高海拔地區(qū)腹腔鏡膽囊切除術(shù)對(duì)血液系統(tǒng)的影響[J];四川省衛(wèi)生管理干部學(xué)院學(xué)報(bào);2009年02期
10 孫永梅;李剛;馬遠(yuǎn)忠;;不同地區(qū)婦科腹腔鏡手術(shù)中CO_2氣腹對(duì)患者呼吸、循環(huán)和動(dòng)脈血?dú)獾挠绊慬J];山東醫(yī)藥;2011年35期
相關(guān)碩士學(xué)位論文 前2條
1 李東亮;腹腔鏡手術(shù)對(duì)血液凝血纖溶系統(tǒng)的影響[D];鄭州大學(xué);2010年
2 李友偉;腹腔鏡手術(shù)對(duì)血管內(nèi)皮細(xì)胞損傷分子標(biāo)志物及凝血纖溶系統(tǒng)的影響[D];重慶醫(yī)科大學(xué);2005年
，本文編號(hào)：2446437
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2446437.html
最近更新
教材專著
