腹腔镜手术治疗卵巢子宫内膜异位症对患者止血功能的影响

摘要

目的 研究开腹手术(AH)和腹腔镜手术(LH)对卵巢子宫内膜异位症患者止血功能的影响.方法 选择60例子宫内膜异位症患者,ASA Ⅰ～Ⅱ级,将其随机分为两组,每组30例,分别行AH和LH.分别于麻醉前,术中15 min、30 min、60 min和术毕,术后24 h、48 h、72 h共8个时间点抽取外周静脉血测量两组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血小板计数(PLT)、D-二聚体(DD)、纤维蛋白原(FBG)和血管性血友病因子(vWF)的含量.结果 两组患者术中15 min、30 min、60 min和术毕时PT、APTT、TT均较麻醉前延长,但是AH组较LH组延长更明显(P＜0.05).两组患者术毕和术后24 h、48 h PLT、FBG的含量均较麻醉前降低,但相同时间点PLT和FBG AH组较LH组降低更明显(P＜0.05).两组患者术后24 h、48 h DD和vWF的含量均较麻醉前升高(P＜0.01),但相同时间点DD和vWF AH组较LH组升高更明显(P＜0.05).结论 腹腔镜下卵巢子宫内膜异位症手术较传统开腹手术对机体的凝血功能影响相对较小.%Objective To explore the effect of laparotomy surgery (AH) and laparoscopic surgery (LH) on hemostatic function in patients with ovarian endometriosis.Methods 60 ASA Ⅰ-Ⅱ patients with endometriosis were selected and then randomly divided into two groups,30 for each group.The two groups received AH or LH.Prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),platelet count,D-dimer,fibrinogen,and von Willebrand factor content were detected before anesthesia,at 15,30,and 60 minutes during anesthesia,completion of procedure,and 24,48,and 72 h after anesthesia.Results As compared with the baselines,PT,APTT,and TT were prolonged in group AH and group LH at 15,30,and 60 minutes during anesthesia,and completion of procedure (P＜0.05),and they were longer in group AH than in group LH (P＜0.05).The contents of PLT and FBG were declined in both groups at completion of anesthesia and 24,48,and 72 after anesthesia as compared with the baselines (P＜0.05),and they were lower in group AH than in group LH at the same time points after anesthesia (P＜0.05).The contents of DD and vWF were significantly higher in both group AH and group LH as compared with the baselines (P＜0.01),and they were significantly higher in group AH than in group LH at the same time points after anesthesia (P＜0.05).Conclusions Laparoscopic surgery has less effect on hemostatic function than laparotomy surgery in patients with ovarian endometriosis.