The Effect Of Total Hysterectomy With Different Operative Approaches On The Vascular Endothelial Cells And The Lower Extremities Venous Pressure

ObjectivesTo compare the effect of total hysterectomy with different operative approaches onthe markers of endothelial cell injury and the lower extremities venous pressure.Materials and Methods99cases hysterectomy patients were observed in our hospital for uterine benignlesions (such as uterine fibroids, adenomyosis, etc.) from July2011to April2013.average age of48.49±3.02（range45-55）; uterine volume≤12weeks of gestation; withoutfertility requirements; without uterine prolapse and vaginal anterior and posterior wallprolapse; without combined medical and surgical diseases; Cases of malignant tumors andrisk factors of deep vein thrombosis (history of thrombosis, hypertension, coronary heartdisease, history of diabetes, etc.) were excluded. There was no significant difference of allenrolled patients’ age, body mass index, operative time, blood pressure, etc. Patientssigned an informed consent agreement and we reported to the hospital ethics committee fortheir approval to this study. All enrolled patients were divided into total laparoscopichysterectomy (TLH) group with36cases and transvaginal hysterectomy(TVH)group with32cases and transabdominal hysterectomy(TAH) group with31cases. Plasma vonWillebrand factor(vWF), thrombomodulin (TM) and D-dimer(D-D) were determinedpreoperative, and0and6and24hours after the operation in all patients. Dynamicmonitoring numerical changes of lower extremity venous pressure and recorded till the endof operation. To compare the varieties after total hysterectomy with different operativeapproaches on the vascular endothelial cells and the lower extremities venous pressure.The data were statistically analyzed using SPSS13.0statistical software. Themeasurement data were presented as (x±S), and paired sample t-test, one-factor ANOVA,Student-Newman-Keuls,variance analysis for two-factor repeated measurement data were performed to analyze the data, and a p value of <0.05was considered significant.Results(1) The endothelial cell damage markers, vWF and TM increased significantly atpostoperative0h (P<0.05). TLH had the most highest significantly(P<0.05) amongdifferent groups in TLH,TVH and TAH.TVH and TAH were similar. At postoperative6h,plasma TM in TLH had the most highest(P<0.05) among different groups in TLH,TVHand TAH. Not significantly different was found in the comparison between TVH and TAH.But among different groups,plasma vWF were similar.Plasma D-D had more significantlyincreased at postoperative0h than those of preoperative,TLH had the most significantlyincreased among different groups. In both TVH and TAH, not significantly different wasfound P>0.05. In TLH,D-D still remained higher24h later than those of the momentoperation finished P<0.05.Furthermore,there were significantly different among differentgroups(TLH group>TAH group>TVH group,P<0.05).D-D reduced significantly, comparedwith the changes between postoperative24h and postoperative6h and among differentgroups in TLH、TVH and TAH.24h after operation, the changes of plasma D-D inTVH,compared with TAH, were not statistically significant (P>0.05).(2) Compared with supine position,both the modified lithotomy position and thetraditional lithotomy position were significantly higher, TLH>TVH>TAH (P<0.01);Underwent the modified lithotomy position with head down15°and the traditionallithotomy position with head down5°, lower extremities venous pressure weresignificantly decreased(P<0.01); After CO2pneumoperitoneum established, lowerextremities venous pressure were elevated compared with the previous(p<0.01).Conclusions(1) vWF、TM、D-D：Plasma level of vWF and TM after TLH were the most seriousamong different groups. But short duration.Plasma level of D-D after TLH weresignificantly higher than that the same time after operative in the TVH group and TVHgroup (P<0.05), Prompted body hypercoagulable state and hyperfibrinolysis in the TLHgroup was more serious than others. but postoperative recovery were faster than others. theprevention of venous thrombosis are necessary in total hysterectomy with differentoperative approaches. Especially in LTH within6hours after Surgery shall take measuresto prevent thrombosis.(2) To compared the modified lithotomy position,the traditional lithotomy positionand the establishment of the CO2pneumoperitoneum, Lower extremities venous pressurewas significantly elevated and venous blood siltation and the formation of deep vein thrombosis.(3) Both the modified lithotomy position with head down15°and the traditionallithotomy position with head down5°could relieve lower extermities venous pressurewithin a certain range.(4) lower extremities venous pressure would change with the changes ofintra-operative,Intra-operative positioning represents a modifiable risk factor for deepvenous thrombosis.