The Effects And Prevention Of Laparoscopic Surgery For Gastric Cancer On Femoral Venous Hemodynamics And Coagulation Function

Objective:1. To study the effect of the establishment of CO₂ pneumoperitoneum, the feet-down tilt position and the prolongation of surgeric time during laparoscopic surgery for gastric cancer on femoral venous hemodynamics and coagulation function.2. To study the effect of Intermittent Sequential Pneumatic Compression (ISPC) Device on femoral venous hemodynamics during laparoscopic surgery for gastric cancer and its possible mechanism.3. To study the effect of Xiesaitong Injection on coagulation function after laparoscopic surgery for gastric cancer and its possible mechanism.Methods:1. Color Doppler ultrasound was adopted to evaluate the diameter, blood velocity and volume of the blood flow in the lower extremity of thirty patients undergoing laparoscopic surgery for gastric cancer with three kinds of positions (prostration, head-down tilt position and feet-down tilt position), different pressure of CO₂ pneumoperitoneum (8mmHg, 12mmHg, 16mmHg), and the different time during the surgery. Blood coagulation method was used to detect the values of the PT, APTT, FIB and INR, enzyme linked immunosorbent assay(ELISA) was used to detect the value of D-D at preoperation, the end of operation and 3, 5, 7days postoperation.2. Patients undergoing laparoscopic surgery for gastric cancer were divided randomly into the control group and the test group, nothing special was done to the control group during the operation while the test group was given intermittent sequential pneumatic compression on the ankle with 45mmHg, the leg with 40mmHg and the thigh with 30mmHg since the establishment of 12mmHg CO₂ and the feet-down tilt position till the end of operation with prostration and the exhaust of CO₂ gas. Color Doppler ultrasound was adopted to evaluate the diameter, blood velocity and the amount of the blood flow during surgery with two groups. 3. 60 cases undergoing laparoscopic surgery for gastric cancer were divided randomly into the control group and the test group, conventional anti-infection and transfusion was administered to the control group, the test group was treated with 400mg Xuesaitong injection added into 250ml 5% glucose injection (intravenous drip, 1/d, 6 days in a row) since at first day after the operation on the basis of conventional anti-infection and transfusion. Blood coagulation method was used to detect the values of the PT, APTT, FIB and INR, and enzyme linked immunosorbent assay(ELISA) was used to detect the value of D-D at preoperation, the end of operation and 3, 5, 7days postoperation with two groups.Results:1. Compared with prostration, the femoral vein diameter decreases (P<0.05), the velocity and the blood volume increase(P<0.01, P<0.05) in patients with head-down tilt position; the diameter increases(P<0.01), the velocity and the blood volume decrease(P<0.01, P<0.05) with feet-down tilt position or the establishment of the CO₂ pneumoperitoneum; During the surgery, although the femoral vein diameter have no obvious change(P>0.05), the velocity and the blood volume decrease obviously with the lasting of surgery time(P<0.05). At the end of operation with prostration and the exhaust of CO₂ gas,the femoral vein diameter decreases (P<0.01), and the velocity and the blood volume increase(P<0.01), but still less than the level before the pneumoperitoneum(P<0.05). Compared with preoperation,no change was observed of the value of APTT and INR, the value of FIB and D-D increased (P<0.05, P<0.01) and the value of PT decreased (P<0.05 )as the lasting of postoperation time.2. No obvious difference is found on the diameter of femoral vein, the velocity and the blood volume of two groups before the establishment of CO₂ pneumoperitoneum(P>0.05). After the establishment of pneumoperitoneum and the feet-down tilt position, the femoral vein diameter increases in two groups(P<0.01),but that of the test group is smaller to the control group(P<0.01); the velocity and the blood volume decrease(P<0.01) with the control group, and that of the test group increases(P<0.05). With the lasting of surgery time, the femoral vein diameter of two groups have no obvious change(P>0.05), the velocity and the blood volume decrease obviously(P<0.05) in the control group,but that of the test group have no obvious change (P>0.05). There is significant difference between the two groups. And at the end of operation with prostration and the exhaust of CO₂ gas, the femoral vein diameter of the two groups decreases(P<0.01), the velocity and the blood volume of the control group increase (P<0.01), and that of the test group decrease but still larger than the control group(P<0.05).3. There is no significant difference on PT,APTT,INR,FIB and D-D between the two groups before the operation,and no change of APTT and INR was observed after operation. The value of PT decreased ,the value of FIB and D-D increased with two groups (P<0.05) as the lasting of postoperative time, and there is significant difference between two groups (P<0.05,P<0.05,P<0.01).Conclution:1. The establishment of CO₂ pneumoperitoneum, the feet-down tilt position and the prolongation of surgery time during laparoscopic surgery for gastric cancer can interfere with the circulation and coagulation function of blood, which would increase the risk of deep vein thrombosis after the laparoscopy.2. The Intermittent Sequential Pneumatic Compression (ISPC) Device can improve the stage with the increase of the femoral vein diameter, the decrease of the velocity and the blood volume, which due to the establishment of pneumoperitoneum, the feet-down tilt position and prolongation of surgery time during the surgery, and reduce the risk of deep vein thrombosis after the laparoscopy.3. Laparoscopic surgery for gastric cancer can make high agglutination condition, which will increase the risk of deep vein thrombosis, and Xiesaitong Injection can improve this state.