Effect Of Air Pressure Therapy Apparatus On Prevention Of Lower Extremity Deep Vein Thrombosis After Rectal Cancer Radical Resection

Objective: The aim of this study was to detect the effect of air pressure therapy apparatus on prevention of lower extremity deep vein thrombosis(DVT) after rectal cancer radical resection. Methods: One hundred and twenty patients who underwent rectal cancer resection at our center between February 2012 and March 2015 were included in this study according to both inclusion and exclusion. Inclusion criteria included the following:(1) patients aged 18 to 75 years old;(2) patients suffered from rectal cancer;(3) patients underwent rectal cancer radical resection. Exclusion criteria were as follow:(1) cases combined with primary malignant tumors of other systems;(2) preoperative imaging examinations finding distant metastasis;(3) patients underwent palliative resection of rectal cancer;(4) patients accepted antiplatelet treatment or anticoagulant treatment;(5) preoperative examinations finding abnormity of coagulation function and blood platelet count;(6) cases combined with diabetic peripheral vascular disease;(7) patients with previous history of DVT;(8) patients with previous history of myocardial infarction or cerebral infarction;(9) age under 18 years old or more than 75 years old. All of the 120 patients underwent preoperative workup included disease history and physical examination, blood routine examination, coagulation function examination, D-dimer examination, examination of tumor markers, chest radiography, electrocardiography, colonoscopy and duplex ultrasonography of lower extremity. All of the 120 patients were randomly divided into two groups. Sixty patients were divided into control group and the other 60 patients divided into experimental group. The patients of control group accepted conventional treatment of prevention of lower extremity DVT after rectal cancer resection as follow: ankle pump, bend and stretch of the knee joint, more turning of body and early ambulation. The patients of experimental group accepted conventional treatment of prevention of lower extremity DVT all above and additional treatment of air pressure therapy apparatus after rectal cancer resection. All patients underwent blood routine examination, coagulation function examination, D-dimer examination and duplex ultrasonography of lower extremity 72 hours and 1 week after rectal cancer resection, respectively. Two independent samples t-tests and chi-square test were used to compare the differences between the two groups. Results: There were no significant differences in age, gender, body mass index(BMI), preoperative blood platelet count, preoperative coagulation function, preoperative D-dimer and preoperative blood flow velocity of lower extremities deep vein between the two groups. There were 1(1.7%) and 9(15%) patients underwent lower extremity DVT in the experimental group and control group, respectively. The rate of lower extremity DVT in experimental group was significant higher compared to control group(X~2=5.345, P<0.05). There were no significant differences in blood platelet count(PLT), prothrombintime(PT), activated partial thromboplastin time(APPT), thrombin time(TT) between the two groups both 72 hours and 1 week after operation. Patients of experimental group had greater postoperative fibrinogen(FIB)(4.32 ± 0.79g/L, 4.82 ± 0.95g/L), greater postoperative D-dimer(1.32 ± 1.67?g/ml, 2.14 ± 2.36?g/ml), faster postoperative blood flow velocity of popliteal vein(14.86 ± 0.83cm/s, 14.42 ± 0.95cm/s) and faster postoperative blood flow velocity of femoral vein(23.55 ± 1.26cm/s, 22.89 ± 1.38cm/s) compared to the control group at 72 hours after operation. And at 1 week after operation, patients of experimental group also had greater postoperative fibrinogen(FIB)(3.94 ± 0.85g/L, 4.59 ± 1.01g/L), greater postoperative D-dimer(1.07 ± 1.63?g/ml, 1.88 ± 2.30?g/ml), faster postoperative blood flow velocity of popliteal vein(15.14 ± 0.82cm/s, 14.83 ± 0.88cm/s) and faster postoperative blood flow velocity of femoral vein(23.91 ± 0.88cm/s, 23.16 ± 0.91cm/s) compared to the control group. Compared with preoperative status of the two groups, the postoperative PT and APPT were shorter at 72 h after operation and had no significant difference at 1week after operation, the postoperative FIB and D-dimmer were greater at both 72 h and 1week after operation, and the postoperative blood flow velocity of popliteal vein and femoral vein were slower at 72 h after operation, and experimental group had no significant difference in postoperative blood flow velocity of popliteal vein and femoral vein at 1week after operation, but the postoperative blood flow velocity of popliteal vein and femoral vein of controll group were still slower. Conclusion:(1) Patients underwent rectal cancer resection had shorter postoperative PT and APPT, greater postoperative FIB and D-dimmer, slower postoperative blood flow velocity of popliteal vein and femoral vein, and were in a relatively hypercoagulable state. Are more likely to have lower extremity DVT;(2) The use of air pressure therapy apparatus could improve postoperative hypercoagulable state, accelerate blood flow of lower extremities deep vein, and significantly reduced lower extremity DVT after rectal cancer resection.