Comparative Study On Deep Venous Thrombosis In Patients Underwent Hysterectomy

Objective: To explore the incidence of deep vein thrombosis after Differenthysterectomy surgery(laparoscopic hysterectomy group and conventionalhysterectomy group), we compared the difference between two groupspreoperative and postoperative in HGB, PLT, PT, APTT, Fib, and analyzed therisk factors and effective detection index of deep vein thrombosis afterhysterectomy.Methods: A total of40patients who were admitted to the department ofobstetrics and gynecology in the Second Hospital of Hebei Medical Universityfrom December2011to March2012,were included in the study. Age wasolder than40years(average age is52years), anesthesia was Generalanesthesia. All the patients were not given antithrombotic therapy. Patientswere divided into laparoscopic surgery group and the conventional surgerygroup, each group has20patients, including18abdominal hysterectomy,2vaginal hysterectomy and20laparoscopic hysterectomy. Every patient hadbeen examined in HGB, PLT, PT, APTT, Fib and D-Dimer when they wereadmitted. If D-Dimer>0.5ug/ml,the patient should have a lower limb venousultrasonography to make sure Whether there had deep vein thrombosis beforethe surgery, exclude the study group If there exists. All the patients shoulddetermine the degree of risk of postoperative deep venous thrombosis accordeto DVT risk assessment of gynecological surgery(Table1) after the surgery,Divided into low risk, medium risk and high risk group. Review of HGB, PLT,D-Dimer, PT, APTT, Fib on the second day and examinate lower limb venousultrasonography on the forth day after the surgery, according the result oflower limb venous ultrasonography to diagnosis postoperative deep venousthrombosis. Collect patients' age, body mass index(BMI),medical history,HGB,PLT,PT,Fib,APTT and D-Dimer both preoperative and postoperative, surgical approach,operative time, blood loss and braking time. Comparing theincidence of deep vein thrombosis after the surgery between laparoscopicsurgery group and the conventional surgery group; comparing the differenceof overall patients' operative time, D-Dimer,HGB,PLT,PT,APTT and Fibboth preoperative and postoperative between laparoscopic surgery group andconventional surgery group; comparing the difference of low-risk, mediumrisk, high-risk group patients' operative time, D-Dimer,HGB,PLT,PT,APTT and Fib both preoperative and postoperative; comparing the differenceof operative time, D-Dimer,HGB,PLT,PT,APTT and Fib both preoperativeand postoperative between the patients with and without postoperative deepvenous thrombosis; statistic the sensitivity and specificity of the D-Dimer inthe diagnosis of deep venous thrombosis after hysterectomy.Results: In all40patients, laparoscopic surgery group has20cases,including5cases of low-risk group,7cases of medium risk group,8cases ofhigh-risk group; conventional surgery group has20cases, including5cases oflow-risk group,8cases of medium risk group,7cases of high-risk group;6cases had deep vein thrombosis after the surgery, total rate is15%.5casesBelong to laparoscopic surgery group, the rate of this group is20%(5/20);1case was vaginal hysterectomy surgery, the rate of conventional surgery groupis0.5%(1/20).2cases were Uterine myoma;2cases were endometrialcarcinoma;1case was endometrial polyps;1case was Uterine prolapsed.2cases had hysterectomy;2cases had Hysterectomy+Bilateral oophorectomy;1case had Hysterectomy+bilateral oophorectomy+Pelvic lymph nodedissection；1case had Vaginal hysterectomy.40-49years old in2cases;50-59years old in2cases;60-69years old in2cases.3cases with hypertension;1cases with diabetes;The other2cases no past medical history.6cases withDVT's operative time was187.5±54.93min, the remaining34cases'operative time was121.62±45.71min, compared to P=0.009<0.05, haddifference between the two group. According to the result of lower limbvenous ultrasonography,1case with deep venous thrombosis,3cases may existfor deep vein thrombosis,2cases were before the state.2cases occurred in right lower limb,other4occurred in lower limbs. After the surgery,5cases'D-Dimer were higher than0.5ug/ml,1case was lower than0.5ug/ml; In34cases which were without deep vein thrombosis,16cases' D-Dimer werehigher than0.5ug/ml,18cases were lower than0.5ug/ml.The sensitivity andspecificity of D-Dimer were83.3%,52.9%.Comparing of D-Dimer Betweenthe group of postoperative DVT and did not occur,Ppre=0.85>0.05, Ppost=0.171>0.05, both of them had no significant difference.There had Decreasedin varying degrees of HGB,PLT,APTT and slightly increased of Fib,PT aftersurgery.Conclusions: The Incidence of deep vein thrombosis after laparoscopichysterectomy is higher than conventional hysterectomy surgery; tumor, age,previous hypertension and diabetes are the risk fators of deep venousthrombosis after hysterectomy; longer operative time is a good condition fordeep venous thrombosis after hysterectomy; D-Dimer has higher sensitivityand lower specificity when used to diagnose deep venous thrombosis afterhysterectomy;There is no significant difference between preoperative andpostoperative in HGB,PLT,PT,APTT,Fib. However, each group was nosignificant difference.