Clinical Reserch On The Factors Related To Thrombotic Diseases In Gynecological Perioperative Period

Objective To explore the incidence,risk factors,test index,diagnosis and treatment of gynecological pelvic surgery.MethodsData of patients with gynecological inpatient operation in the first affiliated hospital of USTC(Anhui provincial hospital)from August 2015 to July 2017 were collected.There were 8,180 cases of surgical patients.36 patients with deep venous thrombosis after surgery were selected as subjects(thrombus group),145 patients with no thrombus in gynecologic pelvic surgery were selected as the control group(match according to the statistical requirement of 1:4).The age,height,weight,disease type,complications,operation mode,operation time,intraoperative blood loss,preoperative and postoperative coagulation function laboratory indexes and blood glucose values of all patients were calculated.Retrospective analysis was perfonned on the patient data in both groups.Results(1)A total of 8180 patients with gynecological surgery in hospital,among them,597 cases of malignant tumor,7583 cases of benign diseases.There were 20 cases of malignant tumors in the thrombus group,16 cases of benign diseases,48 cases of malignant tumors in the control group and 97 cases of benign diseasesThe total probability of postoperative thrombosis is 0.44%,and the total probability of postoperative thrombosis of malignant tumor and benign disease is 3.35%and 0.21%respectively.Of all the patients,949 had abdominal surgery,6,300 had laparoscopic surgery and 931 had vaginal surgery.In the thrombus group,there were 15 cases of transabdominal surgery,17 cases of laparoscopic surgery and 4 cases of transvaginal surgery In the control group,there were 23 cases of transabdominal surgery,117 cases of laparoscopic surgery and 5 cases of transvaginal surgery The total probability of thrombosis after abdominal surgery,laparoscopic surgery and transvaginal surgery was 1.58%,0.27%and 0.43%,respectively.The age of thrombus group was(52.72±10.38)years old,the age of control group was(42.28±10.54)years old,and there were no young patients under 40 years old in the thrombus group.(2)After gynecological operation,DVT was born in the deep vein of the left lower extremity,which accounted for 63.89%of the total thrombosis patients.(3)Single factor analysis results showed that perioperative DVT of department of gynaecology was significantly associated with older age,obesity,long operation time,intraoperative blood loss,abdominal surgery,malignant tumor,preoperative high d-dimer values,preoperative high PT values,preoperative high FIB values,high blood sugar.(4)Multivariate logistic regression analysis showed that long operation time,preoperative high d-dimer,hyperglycemia,comorbidity and abdominal operation were the risk factors for postoperative DVT.Compared with abdominal surgery,laparoscopic surgery and vaginal surgery are protective factors(P<0.05).(5)Postoperative d-dimer,PT and FIB of the thrombus group were significantly higher than those in the control group(P<0.05),which was statistically significant.(6)There was no correlation between high preoperative APTT value and increased postoperative APTT value and postoperative DVT.Conclusion(1)After gynecology,DVT mostly occurred in the lower limb,left side more than right side.(2)Long operation time,preoperative d-dimer,hyperglycemia,comorbidity and abdominal surgery were independent risk factors for DVT in gynecological perioperative period.(3)Patients with advanced age,obesity,malignant tumor,long operative time and high intraoperative blood loss have effects on postoperative deep venous thrombosis.(4)The changes of d-dimer,PT and FIB were observed before and after the operation,and there was some value in the prevention and diagnosis of postoperative thrombosis.