Analysis Of Factors On Lower Extremity Deep Vein Thrombosis In Different Kinds Of Gynecological Surgery Of Patients

Objectives Analysis of252cases of gynecologic surgery patients (including125casesfrom laparoscopic surgical group and127cases from open surgery group) and laparotomypostoperative deep vein thrombosis (DVT) of lower limb, assessing risk factors affectingthe formation of DVT, laboratory index, early screening methods and preventive measures.Methods Choose252cases of surgical patients from November2012to September2013in hebei united university affiliated hospital and health care of women and children’s wardsof department of gynaecology to qinhuangdao, which is according to the kinds of diseasesand the patients’ own wishes, divided into laparoscopic group, including127cases, inwhich14patients have attacked by malignant diseases, the rest for the patients with benigndisease, and laparotomy group, made up of125patients, including20patients withmalignant diseases, the rest for benign disease. patient’s age, weight coefficient are(48.43±6.43),(25.39±3.68)kg/m2,(49.15±6.73),(26.13±3.94)kg/m2in the two group.According to the statistical analysis, there is no difference between the age, weight ofpatients in two groups (P>0.05). All surgical patients assay hemoglobin (HGB), plateletcount (PLT), prothrombin time (PT), thrombin time (TT), activated partial clotting enzymelive time (APTT), fibrinogen (Fib) content, D-dimer (D-dimer) respectively within7daysbefore surgey, the second day after surgery. All patients in preoperative7days are checkedbilateral iliac vein and bilateral lower limb vein of color doppler ultrasound, making surewhether there are patients with DVT, and checked again in4～7days after operations. Andgive physical therapy and (or) low molecular heparin calcium in patients who have agreedwith these measures according to the general information of patients, operation time,patients own wills.Usually, physical therapy is one time a day, with risk factors can beincreased to2times, period of treatment is commonly3～5days (which can be extendedto7days).Low molecular heparin calcium usually is used in the second day,1～2timesone day, lasting about5to7days.Dispose all patients’ ages, weight coefficients, history ofchronic diseases,HGB, PLT and PT, TT, APTT, Fib, D-dimer before and after surgery,operation time, intraoperative blood loss, postoperative exhaust time, postoperative urinetube pull out time.Analysis of the incidence of postoperative DVT of252patients and theincidence of DVT in two groups of patients;comparison on HGB, PLT, PT, TT, APTT, Fib,D-dimer before and after surgery in252patients;Comparison of HGB, PLT, PT, TT,APTT, Fib, D-dimer between laparoscopic surgery group and open operation group ofoperative patients, operation time, intraoperative blood loss, postoperative exhaust timeand the urine tube time pulled out;Analysis the results of patients with thrombosis afterinterventions postoperatively;Analysis of the high risk factors of DVT, laboratory indexes,early screening plans and prevention measures.Results1The incidence on DVT of252patients was7.1%, the incidence of DVT is 7.9%of laparoscopic group,which is6.4%in laparotomy group, there is no differencebetween the two groups (P>0.05).2In18patients with DVT,7cases occurred in the leftlower limb,8cases in the right lower limb, other3occurred in double lower limbs.3Theincidence of DVT in patients with malignant diseases is higher than patients with benigndiseases(P<0.05), while there is no difference between two groups in benign diseases andmalignant diseases.4The longer of operation time, the higher the chances of DVTformation (P<0.05).At the same time, there is no difference between two kinds of groups.5Age, weight, weight coefficient, high blood pressure, diabetes, coronary heart disease,tumor, long operative time, intraoperative bleeding, spending long time beforepostoperative exhaust and postoperative urethral catheter time are the risk factors of deepvenous thrombosis.6There is of significant difference between preoperative andpostoperative in HGB, PLT, PT, APTT, TT, Fib, D-dimer(P<0.05), however, there is ofsignificant difference in TT, D-dimer between two groups(P<0.05).7Intraoperatie bloodloss of patients with laparoscopic group is more than laparotomy group patients (P<0.05),while operative time, fart time, indwelling catheter time are no significant difference (P>0.05).87cases with DVT having no obvious symptoms in10cases of laparoscopic groupand4cases in8cases of laparotomy group are diagnosisd by ultrasound. The sensitivityand specificity of D-dimer are94.4%and8.5%.9There are15cases of thrombosis in211cases of patients with postoperative give intervention(7.1%), however there are3cases ofthrombosis in41uncured patients(7.3%), each group is no significant difference(P>0.05).Conclusions1Laparoscopic surgery and conventional surgery can induce lowerextremity deep vein thrombosis, there is no significant difference in the incidence of deepvein thrombosis between the two groups.2Age, weight, weight coefficient, high bloodpressure, diabetes, coronary heart disease, tumor, long operative time, intraoperativebleeding, spending long time before postoperative exhaust and postoperative urethralcatheter time are the risk factors of deep venous thrombosis.3The incidence of DVT inpatients with malignant diseases is higher than patients with benign diseases, while there isno difference between two groups in benign diseases and malignant diseases.4The longerof operation time, the higher the chances of DVT formation. At the same time, there is nodifference between two kinds of groups.5Plasma D-dimer and ultrasound examination,can carry on the effective screening to the formation of postoperative DVT.6Gynecological surgery application of low molecular heparin and lower limbs ofintermittent pressure have certain effect to preventing the formation of the lower extremityDVT.