The Clinical Study Of Effect Of Gynaecology Laparoscopy On Blood Coagulation In Human Body

OBJECTIVE: To examine interrelated values of coagulation and anticoagulation system before and after laparoscopic and open gynaecology surgery. To understand the different effect on blood coagulation in human body of the two surgery method. And to provide basis for DVT prophylaxis after laparoscopic gynaecology surgery. STUDY DESIGN: One hundred patients hospitalized at the same time between March and December 2002 were randomly selected ( laparoscopic (n=55) or open (n=45) gynaecology surgery) .There was not any DVT prophylaxis. The Platelet( PLT ), Prothrombin Time(PT), Activated Partial Thromplastin Time(APTT), Thrombin Time(TT),Fibrinogen(FBG),Antithrombin III(AT-III),D-dimer,and Protein C (PC) levels were measured at baseline and within 1h, first and third day postoperatively.And campare results within groups and between groups. RESULTS:The two groups were similar in mean age, mean time of surgery., body mass index (age37.5 ±8 vs 45.2 ± 8; BMI 19.5 ± 3 vs 20 ± 3; mean time of surgery 1.33 ± 0. 77 vs 1. 5 ± 0. 67 P>0.05) . l.PLT: There was no significant difference in platelet levels after laparoscopic and open gynaecology surgery(p>0.05).And there was no significant difference between laparoscopic and open gynaecology surgery(with 1h 173.75 ± 65.83 vs 196.64 ± 62.62; first day 168.59 ± 61.86 vs 184. 50±54. 30; third day 180. 38 ± 41. 40 vs 188. 33 ± 38. 28 P>0.05) .2.PT, APTI\ TT: PT levels increased witnin Ih,first day after laparoscopic gynaecology surgery (with Ih and before surgeryl0.81±0. 63 vs 10.42 ± 0.46; first day and before surgery 10.92 ± 0. 57 vs 10. 42±0. 46. P<0.05 ) . There was significant difference(p<0.05); APTT levels decreased first day after laparoscopic gynaecology surgery. There was significant difference (29.67 ± 3. 94 vs 32.68 + 4. 25. P<0.05) .but there was no significant difference in these levels between groups. ;TT levels remained stable after surgery, but there was significant difference in these levels between groups(p<0.05) and the levels of first day after open gynaecology surgerydecreased more than after laparoscopic gynaecology surgery (18.02 2. 11 vs 16.11 + 2. 29. PO.05) . 3. FBG: FBG levels increased after laparoscopic and open gynaecology surgery(p<0.05),there was no significant difference in these levels between groups (p>0.05) , i.e.coagulation is higher both the two groups after surgery and the effect of the two surgery is equal. 4.D-dimer: D-dimer levels increased in both groups, but the levels were significantly higher after open gynaecology surgery than after laparoscopic gynaecology surgery(p<0.05) within lh,at first day (within 1h 190.50 170.00 vs 300.51 220. 05; first day 480.23 400.00 vs 580.43 330. 23. P<0.05) . 5. AT-III and PC: AT-III levels and PC levels was significantly less after laparoscopic and open gynaecology surgery (p<0.05).The reduction of AT-III (within Ih 96.05 9. 02 vs 85. 05 13. 02. P<0.05)) and PC( third day 80.50 10.50 vs71.50 14.30. P<0.05 ) was significantly less after laparoscopic gynaecology surgery than after open gynaecology.CONCLUSIONS: Laparoscopic and open gynaecology surgery induce up-regulation of coagulation system and down-regulation of anticoagulation system ,and induce a hypercoaguloble state after surgery. But open gynaecology surgery induce a higher coagulation than laparoscopic gynaecology surgery .