[1]刘晨 韩子良 张能维 彭吉润 朱斌 杜德晓 张东东 宫轲**.腹腔镜胃袖状切除手术对肥胖患者凝血系统的影响[J].中国微创外科杂志,2019,01(10):910-914.
　Liu Chen,Han Ziliang,Zhang Nengwei,et al.Effects of the of Laparoscopic Sleeve Gastrectomy for Coagulation System in Obese Patients[J].Chinese Journal of Minimally Invasive Surgery,2019,01(10):910-914.
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腹腔镜胃袖状切除手术对肥胖患者凝血系统的影响()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2019年10期
页码:
910-914
栏目:
临床研究
出版日期:
2019-10-25

文章信息/Info

Title:
Effects of the of Laparoscopic Sleeve Gastrectomy for Coagulation System in Obese Patients
作者:
刘晨 韩子良 张能维 彭吉润 朱斌 杜德晓 张东东 宫轲**
（首都医科大学附属北京世纪坛医院普外科，北京100038）
Author(s):
Liu Chen;  Han Ziliang;  Zhang Nengwei;  et al.
Department of General Surgery,Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
关键词:
肥胖; 腹腔镜减重手术; 凝血系统
Keywords:
Obesity; Laparoscopic bariatric surgery; Coagulation system
文献标志码:
A
摘要:
目的探讨腹腔镜胃袖状切除术（laparoscopic sleeve gastrectomy，LSG）对肥胖患者凝血系统的影响。方法选择2016年4月~2018年4月LSG 49例。术前BMI 44.5±8.2。手术均由同一术者完成，气腹压力13 mm Hg。术前、气腹结束时（术后0 h）、24 h抽血测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D-D）、血小板计数(PLT)、红细胞计数(RBC)、红细胞压积(HCT)、血小板压积(PCT)、总胆固醇（CHOL）、甘油三脂（TRIG）和钙离子（Ca）。术前、术后24 h行下肢血管超声检查。结果49例均成功实施LSG，术后随访1个月，无严重手术并发症。术前49例凝血功能指标均正常。PT在术后0 h、24 h较术前延长［（12.3±0.7）s、（12.5±0.8）s vs. （11.2±0.8）s，P=0.000、0.000］。APTT在术后0 h、24 h较术前缩短［（29.6±3.7）s、（29.0±3.2）s vs.（31.3±3.4）s，P=0.011、0.001］。D-D在术后0 h较术前升高［（210.3±111.1）ng/ml vs. （85.7±112.1）ng/ml，P=0.000］，术后24 h较术后0 h亦升高［（432.5±205.1）ng/ml vs. （210.3±111.1）ng/ml，P=0.000］。FIB手术前后无明显变化（P>0.05）。所有患者术前及术后24 h下肢血管超声检查均未发现下肢静脉血栓。结论肥胖患者LSG术后存在血液高凝状态，增加术后24 h内血栓形成的风险，需引起高度重视。
Abstract:
ObjectiveTo investigate the effects of laparoscopic sleeve gastrectomy (LSG) on the coagulation system in obese patients.MethodsForty-nine obese patients underwent LSG between April 2016 to April 2018 and were enrolled into this study. Before the operation, the mean BMI of the patients was 44.5±8.2. The surgery was performed by the same surgeon with the pressure of pneumoperitoneum maintained at 13 mm Hg. Venous blood specimens were taken from each patient before surgery, at the end of pneumoperitoneum (0 h after surgery), and at 24 hours after surgery for determination of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D), platelet (PLT), red blood cell (RBC), hematocrit (HCT), plateletcrit (PCT), cholesterol (CHOL), triglyceride (TRIG) and serum calcium (Ca). All the patients were examined by color Duplex sonography before surgery and at 24 hours after surgery respectively.ResultsAll the 49 obese patients successfully underwent LSG, and no severe operation-related complications were observed during 1 month follow-up after operation. The coagulation levels were within normal range before surgery. The PT values were increased at 0 h and 24 h after surgery compared to those before surgery ［(12.3±0.7) s and (12.5±0.8) s vs. (11.2±0.8) s, P=0.000 and 0.000］. The APTT values at 0 h and 24 h after surgery were decreased compared to those before surgery ［(29.6±3.7) s and (29.0±3.2) s vs. (31.3±3.4) s, P=0.011 and 0.001］. However, the D-D values was increased at 0 h after operation compared with the values before surgery ［(210.3±111.1) ng/ml vs. (85.7±112.1) ng/ml, P=0.000］, and was also increased at 24 h after operation compared with the values 0 h after operation ［(432.5±205.1) ng/ml vs. (210.3±111.1) ng/ml, P=0.000］. The FIB values were not significantly different after operation compared with the values before surgery (P>0.05). The color Duplex sonography examination results showed that no lower limb vein thrombus was found before surgery and at 24 hours after surgery.ConclusionsLSG may cause postoperative hypercoagulability of obese patients, which increases the risks of thrombosis within 24 hours after surgery. More attention should be paid.

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备注/Memo

备注/Memo:
基金项目：首都医科大学附属北京世纪坛医院院内基金**通讯作者，E-mail：gongke6688@yahoo.com
更新日期/Last Update: 2020-01-09