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目的比较腹腔镜与开腹手术对胃癌患者术后血凝状态的影响,为临床围手术期血栓形成预防措施的制定提供依据。方法前瞻性收集笔者所在医院科室于2014年2月至2014年8月期间收治的100例胃癌患者,采用随机数字表法分为腹腔镜组和开腹组,每组50例。开腹组患者接受传统开腹手术治疗,腹腔镜组患者接受腹腔镜手术治疗,比较2组患者的临床治疗效果和血凝状态。结果 (1)手术指标。腹腔镜组患者的手术时间、术中出血量、肛门排气时间、住院时间及并发症发生率均短于或低于开腹组(P<0.05)。(2)凝血指标。与术前比较,术后24 h腹腔镜组和开腹组患者的凝血酶原时间(PT)均缩短(P<0.05),但2组患者手术前后的活化部分凝血活酶时间(APTT)和国际标准化比率(INR)比较差异均无统计学意义(P>0.05)。不管是术前还是术后24 h,同时点腹腔镜组和开腹组患者的PT、APTT及INR比较差异均无统计学意义(P>0.05)。(3)纤溶指标。与术前比较,术后24 h腹腔镜组和开腹组患者的纤维蛋白原(FIB)和D-二聚体(D-dimer)水平均升高(P<0.05)。术前腹腔镜组和开腹组患者的FIB和D-dimer水平比较差异均无统计学意义(P>0.05),但术后24 h腹腔镜组患者的FIB和D-dimer水平均较开腹组高(P<0.05)。(4)随访结果。2组患者的转移率、复发率及死亡率比较差异均无统计学意义(P>0.05),但腹腔镜组患者的血栓发生率高于开腹组(P<0.05)。结论在胃癌患者的治疗过程中,腹腔镜手术具有创伤小、出血量少、并发症少等优势,但腹腔镜手术和开腹手术均可使患者的血液处于高凝状态,且腹腔镜术后患者的血液高凝状态更加明显。
Objective To compare the effect of laparoscopy and laparotomy on the postoperative coagulation status in patients with gastric cancer and provide the basis for the development of perioperative thrombosis preventive measures. Methods We prospectively collected 100 gastric cancer patients who were admitted to our hospital department from February 2014 to August 2014 and divided them into laparoscopic group and open group with 50 cases in each group. The patients in laparotomy group underwent traditional laparotomy. The laparoscopic group patients underwent laparoscopic surgery. The clinical effects and coagulation status were compared between the two groups. Results (1) Surgical criteria. The operation time, blood loss, anal exhaust time, hospitalization time and complication rate in laparoscopic group were both shorter and shorter than those in laparotomy group (P <0.05). (2) coagulation index. Compared with preoperation, the prothrombin time (PT) of patients in laparoscopic group and laparotomy group 24 hours after operation was shortened (P <0.05). However, the active partial thromboplastin time (APTT) International standardization ratio (INR) showed no significant difference (P> 0.05). There was no significant difference in PT, APTT and INR between the laparoscopic group and the laparotomy group (P> 0.05), no matter in preoperative or postoperative 24 h. (3) fibrinolysis index. Compared with preoperative, the levels of fibrinogen (FIB) and D-dimer in laparoscopic group and open group increased 24 h after operation (P <0.05). There were no significant differences in FIB and D-dimer levels between preoperative laparoscopic group and open group patients (P> 0.05), but the levels of FIB and D-dimer in laparoscopic group were significantly higher than those in laparoscopic group Group high (P <0.05). (4) follow-up results. There was no significant difference in the metastasis rate, recurrence rate and mortality between the two groups (P> 0.05). However, the incidence of thrombosis in laparoscopic group was higher than that in open group (P <0.05). Conclusions In the course of treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less bleeding and less complications, but laparoscopic surgery and laparotomy can make the patient’s blood hypercoagulable state, and laparoscopic surgery The patient’s blood hypercoagulability state more pronounced.