楊林 1 , 蔡端 1 , 祁光裕 2
  • 1.復旦大學華山醫(yī)院普外科(上海 200040);;
  • 2.西安交通大學醫(yī)學院第一附屬醫(yī)院普外科(西安 710061);

目的  探討腹腔鏡手術圍手術期下肢深靜脈血栓形成(DVT)的相關危險因素。方法  回顧分析復旦大學華山醫(yī)院2007年3月至2008年1月期間收治的16例腹腔鏡術后DVT患者的臨床資料,并與同期148例腹腔鏡手術后無下肢DVT者的資料進行比較,分析其相關危險因素。結果  手術時間>1 h者發(fā)生DVT的危險性是手術時間≤1 h者的4.15倍〔OR=4.15(95% CI: 1.36~12.68)〕,接受下腹部手術者發(fā)生DVT的危險性是接受中上腹部手術者的2.94倍〔OR=2.94(95% CI: 1.07~8.08)〕,高危者(高危因素≥3個)發(fā)生DVT的危險性是低危者(高危因素<3個)的3.94倍〔OR=3.94(95% CI: 1.38~11.23)〕。結論  腹腔鏡術后下肢DVT可能與手術時間長短、手術部位及術前高危因素的存在密切相關。圍手術期應積極應對、積極處理,預防其發(fā)生。

引用本文: 楊林,蔡端,祁光裕. 腹腔鏡術后下肢深靜脈血栓形成的相關因素分析. 中國普外基礎與臨床雜志, 2009, 16(6): 425-428. doi: 復制

1. 張培華, 蔣米爾主編. 臨床血管外科學 [M]. 第2版. 北京: 科學出版社, 2007: 568.
2. 馮力民, 夏恩蘭. 腹腔鏡術后深靜脈血栓的研究 [J]. 中國內鏡雜志, 1999; 5(4): 20-22.
3. 張勇, 陳延山, 王義欣, 等. 腹腔鏡膽囊切除術后靜脈血栓12例分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5(11): 888-889.
4. 肖剛. 腹腔鏡術后下肢靜脈血栓28例分析 [J]. 腹腔鏡外科雜志, 2006; 11(6): 508-509.
5. Jorgensen JO, Hanel K, Lalak NJ, et al. Thromboembolic complications of laparoscopic cholecystectomy [J]. BMJ, 1993; 306(6876): 518-519.
6. Brown JA, Garlitz C, Gomella LG, et al. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy [J]. Urol Oncol, 2004; 22(2): 102-106.
7. 陳平康, 徐志成, 過建工, 等. 腹腔鏡膽囊切除術后下肢靜脈血栓形成 [J]. 生物醫(yī)學工程與臨床, 2001; 5(3): 157.
8. Patel MI, Hardman DT, Nicholls D, et al. The incidence of deep venous thrombosis after laparoscopic cholecystectomy [J]. Med J Aust, 1996; 164(11): 652-654, 656.
9. Milic DJ, Pejcic VD, Zivic SS, et al. Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy [J]. Surg Endosc, 2007; 21(9): 1588-1592.
10. Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan [J]. Ann Surg, 2005; 241(2): 208-216.
11. Maíllo CL, Martín E, López J, et al. Effect of pneumoperitoneum on venous hemodynamics during laparoscopic cholecystectomy. Influence of patients’ age and time of surgery [J]. Med Clin (Barc), 2003; 120(9): 330-334.
12. Fuchs S, Heyse T, Rudofsky G, et al. Continuous passive motion in the prevention of deep-vein thrombosis: a randomised comparison in trauma patients [J]. J Bone Joint Surg Br, 2005; 87(8): 1117-1122.
13. Okuda Y, Kitajima T, Egawa H, et al. A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy [J].Surg Endosc, 2002; 16(5): 781-784.
14. 王秋生, 張陽德譯. 內鏡腹腔鏡外科學 [M]. 北京: 中國醫(yī)藥科技出版社, 2001: 28.
15. 馬玉奎, 趙紀春, 胡志, 等, 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎與臨床雜志, 2008; 15(1): 56-58.
16. 胡大一, 孫藝紅. 血栓栓塞性疾病的規(guī)范防治——ACCP最新溶栓和抗栓指南的啟示 [J]. 臨床薈萃, 2005; 20(15):841-843.
17. Ginzburg E, Cohn SM, Lopez J, et al. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma [J]. Br J Surg, 2003; 90(11): 1338-1344.
18. Colditz GA, Tuden RL, Oster G. Rates of venous thrombosis after general surgery: combined results of randomised clinical trials [J]. Lancet, 1986; 2(8499): 143-146.
19. Flam E, Berry S, Coyle A, et al. Blood-flow augmentation of intermittent pneumatic compression systems used for prevention of deep vein thrombosis prior to surgery [J]. Am J Surg, 1996; 171(3): 312-315.
20. Schaepkens Van Riempst JT, Van Hee RH, Weyler JJ. Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin [J]. Surg Endosc, 2002; 16(1): 184-187.
21. 李友偉, 何平, 李生偉. 老年患者腹腔鏡膽囊切除術后下肢深靜脈血栓形成的預防 [J]. 臨床誤診誤治, 2008; 21(4):62-63.
22. 王海波, 閆西紅, 高麗彩, 等. 低分子肝素鈣預防肥胖患者婦科腹腔鏡手術后深靜脈血栓形成的臨床研究 [J]. 中國內鏡雜志, 2008; 14(3): 266-268.
  1. 1. 張培華, 蔣米爾主編. 臨床血管外科學 [M]. 第2版. 北京: 科學出版社, 2007: 568.
  2. 2. 馮力民, 夏恩蘭. 腹腔鏡術后深靜脈血栓的研究 [J]. 中國內鏡雜志, 1999; 5(4): 20-22.
  3. 3. 張勇, 陳延山, 王義欣, 等. 腹腔鏡膽囊切除術后靜脈血栓12例分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5(11): 888-889.
  4. 4. 肖剛. 腹腔鏡術后下肢靜脈血栓28例分析 [J]. 腹腔鏡外科雜志, 2006; 11(6): 508-509.
  5. 5. Jorgensen JO, Hanel K, Lalak NJ, et al. Thromboembolic complications of laparoscopic cholecystectomy [J]. BMJ, 1993; 306(6876): 518-519.
  6. 6. Brown JA, Garlitz C, Gomella LG, et al. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy [J]. Urol Oncol, 2004; 22(2): 102-106.
  7. 7. 陳平康, 徐志成, 過建工, 等. 腹腔鏡膽囊切除術后下肢靜脈血栓形成 [J]. 生物醫(yī)學工程與臨床, 2001; 5(3): 157.
  8. 8. Patel MI, Hardman DT, Nicholls D, et al. The incidence of deep venous thrombosis after laparoscopic cholecystectomy [J]. Med J Aust, 1996; 164(11): 652-654, 656.
  9. 9. Milic DJ, Pejcic VD, Zivic SS, et al. Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy [J]. Surg Endosc, 2007; 21(9): 1588-1592.
  10. 10. Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan [J]. Ann Surg, 2005; 241(2): 208-216.
  11. 11. Maíllo CL, Martín E, López J, et al. Effect of pneumoperitoneum on venous hemodynamics during laparoscopic cholecystectomy. Influence of patients’ age and time of surgery [J]. Med Clin (Barc), 2003; 120(9): 330-334.
  12. 12. Fuchs S, Heyse T, Rudofsky G, et al. Continuous passive motion in the prevention of deep-vein thrombosis: a randomised comparison in trauma patients [J]. J Bone Joint Surg Br, 2005; 87(8): 1117-1122.
  13. 13. Okuda Y, Kitajima T, Egawa H, et al. A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy [J].Surg Endosc, 2002; 16(5): 781-784.
  14. 14. 王秋生, 張陽德譯. 內鏡腹腔鏡外科學 [M]. 北京: 中國醫(yī)藥科技出版社, 2001: 28.
  15. 15. 馬玉奎, 趙紀春, 胡志, 等, 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎與臨床雜志, 2008; 15(1): 56-58.
  16. 16. 胡大一, 孫藝紅. 血栓栓塞性疾病的規(guī)范防治——ACCP最新溶栓和抗栓指南的啟示 [J]. 臨床薈萃, 2005; 20(15):841-843.
  17. 17. Ginzburg E, Cohn SM, Lopez J, et al. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma [J]. Br J Surg, 2003; 90(11): 1338-1344.
  18. 18. Colditz GA, Tuden RL, Oster G. Rates of venous thrombosis after general surgery: combined results of randomised clinical trials [J]. Lancet, 1986; 2(8499): 143-146.
  19. 19. Flam E, Berry S, Coyle A, et al. Blood-flow augmentation of intermittent pneumatic compression systems used for prevention of deep vein thrombosis prior to surgery [J]. Am J Surg, 1996; 171(3): 312-315.
  20. 20. Schaepkens Van Riempst JT, Van Hee RH, Weyler JJ. Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin [J]. Surg Endosc, 2002; 16(1): 184-187.
  21. 21. 李友偉, 何平, 李生偉. 老年患者腹腔鏡膽囊切除術后下肢深靜脈血栓形成的預防 [J]. 臨床誤診誤治, 2008; 21(4):62-63.
  22. 22. 王海波, 閆西紅, 高麗彩, 等. 低分子肝素鈣預防肥胖患者婦科腹腔鏡手術后深靜脈血栓形成的臨床研究 [J]. 中國內鏡雜志, 2008; 14(3): 266-268.