The Effect Of Laparoscopy On The System Of Blood Coagulation And Fibrinolysis

ObjectiveTo examine interrelated values of blood coagulation and fibrinolysis system before and after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC), and to assess deep venous thrombosis (DVT) risk after laparoscopic surgery by testing blood-specific molecular markers and blood coagulation, which provides a basis for DVT clinical prevention.MethodsWe select 85 cholecystectomy patients, of which 56 patients underwent laparoscopic cholecystectomy (LC) and the other 29 open cholecystectomy (OC) from April to October in 2009. All the selected patients were diagnosed as chronic cholecystitis with gallbladder or gallbladder polyps and within the age of 20-45 years old. Besides all of them were absence of other risk factors for thrombosis, such as the history of thrombosis, obesity, hypertension, hyperlipidemia and diabetes. We didn't use any procoagulant and anticoagulant drugs in perioperative periods. All operations were successfully completed under general anesthesia. Operative time of LC group was 45±16min and OC group was 50±15min. All LC operations were performed with the same laparoscopic equipment, and with the reverse trendelenburg position. And pneumoperitoneum pressure of LC group stabilize at 13mmHg. All surgical patients had no complications. The blood samples of all subjects were collected during 3 days before operation, at the point of operation finished(Oh),24 hours and 72 hours after operation respectively to study changes of the parameters as follows: activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), tissue factor (tissue factor, TF) and D-dimer (DD).Statistical MethodsThe data were signified by mean plus or minus standard deviation (x±SD).The experimental data were analyzed by using a statistical software system named SPSS 10.0. The data intraclass were analyzed by paired samples t test. And for the intergroup comparison, the independent Samples t test was used.Results(1) PT, APTT, TT:After laparoscopic surgery, PT value were higher at the point of operation finished(Oh) and postoperative day. Compared with the preoperative, the difference was statistically significant (P<0.05). While 72 hours after surgery, PT value returned to normal range. For open surgery group, PT value at Oh and 24h after surgery were increased. But compared with the preoperative, the difference was not significant (P>0.05). And there were no difference between the two groups. For APTT values, it gradually decreased after laparoscopic surgery. There was statistical significance compared 24 hours after surgery with preoperative (P <0.05).72 hours after surgery, APTT values returned to normal range. There was no change after operation for open surgery group, and there was no difference between groups. TT values in the two groups did not significantly change surgery. (2)FBG of LC group and OC group elevated progressively after operation and it got its peak at 72h after surgery. It had stastistical difference compared with preoperative and postoperative(P<0.05). There was no significant difference between groups(P >0.05).(3) D-dimer:D-dimer of LC Group were all elevated after Oh,24h and 72h after surgery. Compared with preoperative, it has statistical significance (P<0.05). While D-dimer of 72h was slightly higher than 24h, there was no significance (P> 0.05). For OC group, D-dimer levels increased gradually and its peak pointed at 72h after surgery. Each time point were statistically significant compared with that before surgery (P<0.05). Between the two groups, OC group's D-dimer increased more significantly after Oh,12h and 72h. The difference between two groups was not statistically significant after Oh (P> 0.05). While for 12h and 72h after surgery,it had statistically significant differences (P<0.05). (4) TF:The two groups had a slight increase after surgery. But there was no difference between the two groups and intergroups(P> 0.05).Conclusions(1) Though laparoscopic surgery can minimize invasive surgery, it will increase patients' blood coagulation and activate the body's fibrinolytic system so that the risk of postoperative DVT occurred there.(2) Laparoscopic surgery impacts the extrinsic coagulation pathway greater while impacts the external extrinsic coagulation pathway slighter. It reflects that it is a minimal invasive surgery, which with less damage to body tissues.(3) Laparoscopic surgery increases blood coagulation only in a short-term. There is a short-term high risk of thrombosis. It suggests us that patients with thrombosis risk factors should be closely monitored and given appropriate prevention.