| Background and ObjectivesSince the laparoscopy was first used in the remove of appendix and gallbladder,in the early stage of 1980s,laparoscopic cholecystostomy had gradually developed as the standard style of operation.After twenty years development, laparoscopic surgery is becoming to be accepted by doctors and patients due to many advantadges such as little surgical trauma,little incitatian to patients,light pain after the surgery,rapid recovery and light adhesion,and as the same reason,laparoscopic surgery(LS) has been widely used in many kinds of abdominal diseases which are involved in liver and gallbladder,gastrointestinal diseases,gynecologyc and urinology.However,with the widely usage of the laparoscopic gastroenterotomy and the increase amount of surgery cases,it's recognized that laparoscopic surgery has its shortcomings in itself and comPlications closely related to itself.1860 cases of complications of gynaecologic laparoscopic surgery has been reported by Luo Jianru etc,which involved puncture haemorrhage,subcutaneous animal husbandry blackleg, heart injury and the formation of deepvein thrombosis of lower extremity.Among all of these complications,the last one is a comPlication which may potentially causes disability and death.It's not rarely to see the reports about the occurage of deep vein thrombosis(DVT) after laparoscopic surgery(LS) in the department of liver and gallbladder,obstetrics and gynecologyc,general surgery and urinology,but reported occurage rates vary greatly resPectively.It's reported abroad that underthe condition in which the prevention of thrombosis are regular after and before the surgery,the occurage rate of the deepvein thrombosis(DVT) of lower extreminty with symptoms and signs after laparoscopic surgery(LS) is about 0.3%--0.68%,however,the occurage rate of the deep vein thrombosis(DVT) with no symptoms is apparently increasing,even reaches 55%.The research by Caprini J A,etc also consider that the veins If the patients after laparoscopic surgery(LS) are in high coagulation.Adversely,the research by J.W.Mall etc argue that the occurage rate of traditional exploratory laparotomy after colostomy or proctectomy was higher than that of laparoscopic surgery(LS),but there are no obvious statistical discrepancy comparing with the two groups.As a result,there are three kinds of conclusions about the deep vein thrombosis(DVT) after laparoscopic surgery(LS) and tradintional exploratory laparotomy just as follows:1.Laparoscopic surgery(LS) is a Protective factor for the happen of deep vein thrombosis(DVT), which is more effective for the decrease of deep vein thrombosis(DVT) than traditional exporatory laprotomy.2.Laparoscopic surgery(LS) is a dangerous factor for the happen of deep vein thrombosis(DVT),which has a larger tendancy of increasing the possibility of the haPPen of deep vein thrombosis(DVT).So it's commanded that anti-coagulation measures be taken regularly during the perioperative period.3.There is no discrepancy between laparoscopic surgery(LS) and traditional exploratory laparotomy,and the former has no significant added effect on coagulation.It's quite clear for the resons why the deep vein thrombosis happen right now.At the year of 1946,Vichow had summarized that three main factors which caused the formation of deep vein thrombosis are the injury of veins,the slow blood floating and the high coagulation of blood.Their final result is the formation of thrombosis in the vein duct.Because there are quite a feo dangerous causes of the happen of deep vein thrombosis(DVT) during the perioperative period,such as the injury caused by the surgery itself,the style of surgery,the disease itself(for example, the splitting decomposition of malignant tumor),age(＞60 years old), obesity(BMI＞30kg/m~2) and has a amalgamation of cardiovascular and resPiratory diseases etc,which are likely to increase the Possibility of the Possibility of the happen of deep vein thrombosis(DVT).As a result,one or somemore factors may cause the deep vein thrombosis(DVT) after surgery together.It's very difficult to tell which factor is the direct factor.Objectives:This research considers the patients who suffer from gastroenteric diseases as the observed objects,surveys the changes of coagulation during the perioperative period in laparoscopic gastroenterotomy;and discusses the possibility whether laparoscopic gastroenterotomy will increase the effect on the patients'coagulation comparing with the traditional gastroenterotomy and also the possibility of the formation of deep vein thrombosis(DVT) through comparing with the coagulation condition of patients who undertake the traditional gastroenterotomy during the perioperative period.In a word,this research will evaluate the security of laparoscopic gastroentertomy.Materials and Methods:1.69 cases of the patients who suffer from gastroenteric disease and need operation during April.2008 and October,2008.2.Subsumed standard of the cases:the patiens have no deep vein thrombosis(DVT) or PE history in the past,no history of the surgery of lower libs,no IBD history,BMI≤30kg/m~2,no haemorrhage coagulation obstacles,no diabetes mellitus and no severe liver diseases,no congestive heart diseases,no myocardial infarction and no cerebral embolism history.The female patients have not taken estrogen or contraceptive drugs.All of the patients have not used any anti-coagulation or promoting coagulation drugs.The liver function,the four items of coagulation,plasma glucose are in normal ranges.Altrasonic cardiograph should be regularly implemented for the patients age above 70 years old(ejection fraction＞55%) and the pulmonary function tests are normal.Severe infection or complications haven't taken place after the surgery.3.69 cases of patients are distributed to experimental group(laparoscopic surgery,LS) group and control group(open surgery,OS) and the patients of both two groups will be taken vein blood at the same point of a day before the surgery,1 hour after the surgery,24 hours after the surgery and 72 hours after the surgery.4.The samples taken at the different time point will be delivered to Laboratory after pre-management,test the value of D-Dimer,APTT and PT by ELISA and take a record of them.5.The results will be displayed as data diagram and data graphs and be analyzed to achieve a statistic result by statistic software called SPSS 13.0.6.The patients should be accompanied a month as further consultation after first visit with the doctor as soon as the patients discharge from hospital.Results1.Make a comparison between the preoperative coagulation indications such as D-Dimer,APTT and PT with postoperative 1h,24 and 72h of open group,the result is that D-Dimer has statistic disparity(P＜0.01),72hAPTT has statistic disparity(P＜0.05) and PT has statistic disparity(P＜0.01).2.Make a comparison between the preoperative coagulation indications with postoperative 1h,24 and 72h of laparoscopic group,the result is that D-Dimer has statistic disparity(P＜0.01),72hAPTT has statistic disparity(P＜0.05) and PT has statistic disparity(P＜0.01).3.The contrast of the different time points of the two groups:(1)preoperative D-Dimer not has signifiantly statisticly;preoperative APTT has not signifiantly statisticly;preoperative PT not has signifiantly statisticly.(2) Postoperative 1h D-Dimer not has signifiantly statisticly,APTT has signifiantly statisticly and PT not has signifiantly statisticly.(3) Postoperative 24h D-Dimer not has signifiantly statisticly,APTT not has signifiantly statisticly and PT has signifiantly statisticly. (4) Postoperative 72h D-Dimer not has signifiantly statisticly,APTT not has signifiantly statisticly and PT not has signifiantly statisticly.4.Compare and lithotomy position with prostration in the laparoscopic group: two groups preoperative and postopertative 1h,24h,72h D-Dimer not have statistic disparity,postoperative and postopertative 1h,24h,72h APTT not have statistic disparity,and postoperative and postopertative 1h,24h,72h PT not have statistic disparity.5.Compare aeroperitoneum time more than 120min with less than 120min: two groups postoperative 24h D-Dimer has statistic disparity and 72hAPTT has statistic disparity.6.Two groups of patients with follow-up of one month,there is no clinical symptoms or signs of lower extremity DVT.Conclusions1.Both Laparoscopic and open surgery were at a hypercoagulable state after surgery,but laparoscopic probably more significant.2.Laparoscopic surgery compared with open surgical did not increase the impact of coagulation status.3.Combined the effect of pneumoperitoneum and body position did not increase significantly affect the status of the hemagglutinin. 4.pneumoperitoneum time(laparoscopic surgery time) the longer the status of the impact of hemagglutinin may be more obvious. |
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