免气腹腹腔镜胆道探查术对患者凝血功能的影响

摘要

目的 探讨免气腹腹腔镜胆道探查术对患者凝血功能的影响.方法 选择择期行免气腹腹腔镜胆道探查术的26例患者,分别测定腹壁悬吊前、悬吊中、悬吊后及术后4组血浆样本中组织因子活性(tissue factor activity,TF:A)、凝血酶-抗凝血酶Ⅲ复合物(thrombin-antithrombinⅢcomplexes,TAT)、血浆组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)和纤溶酶原激活物抑制物(plasminogen activator inhibitor-1,PAI-1)的变化.结果 ①TF:A值在4组中差异有统计学意义(P＜0.01),两两比较显示,悬吊后与悬吊前、悬吊中、术后相比差异均有统计学意义(P＜0.01).②TAT值在4组中差异无统计学意义(P＞0.05).③t-PA值在4组中差异有统计学意义(P＜0.01),两两比较显示,悬吊后与悬吊前、悬吊中相比差异有统计学意义(P＜0.01).术后与悬吊前、悬吊中相比差异有统计学意义(P＜0.01).④PAI值在4组中差异有统计学意义(P＜0.01),两两比较显示,悬吊后与悬吊前、悬吊中、术后相比差异均有统计学意义(P＜0.01).结论 免气腹腹腔镜胆道探查术对患者凝血功能的影响处于机体自身可调节范围内,术后早期无高凝状态出现.%Objective To investigate the influence on the coagulation function in the patients undergone gasless laparoscopic bile duct exploration.Methods Twenty-six patients undergone gasless laparoscopic common bile duct exploration were enrolled into this research.Blood samples were collected before,during and after the abdominal wall suspension,as well as the first day after operation.The following plasma molecular markers were measured:tissue-type plasminogen activator (t-PA),thrombin-antithrombin Ⅲ complexes (TAT),tissue factor activity (TF:A) and plasminogen activator inhibitor-1 (PAI-1).Results ①TF:A was significantly increased among the four groups (P ＜ 0.01).Bonferroni post hoc test indicated that TF:A of the post-suspension group was significantly increased compared to the pre-suspension group,mid-suspension group and post-operation group,respectively (P ＜ 0.01).② TAT was not increased significantly among the four groups (P ＞ 0.05).③ t-PA was significantly increased among the four groups (P ＜ 0.01).Bonferroni post hoc test indicated t-PA of the post-suspension group was significantly increased compared to the pre-suspension group and mid-suspension group (P ＜0.01).And t-PA of the post-operation group was significantly increased compared to the pre-suspension group and mid-suspension group (P ＜0.01).④ PAI-1 was significantly increased among the four groups (P ＜0.01).Post hoc multiple comparison indicated that PAI-1 of the post-suspension group was significantly increased compared to the pre-suspension group,mid-suspension group and postoperation group,respectively (P ＜ 0.01).Conclusion Gasless laparoscopic common bile duct exploration activated the coagulation function within the controllable range of the body,and did not lead to hypercoagulation state after operation.