| Objective: To explore the feasibility, safety and its superiority of theapplication of fast track surgery program in patients underwent hysterectomy,,to explore the effect of the fast track surgery on deep venous thrombosis, tocompare the conditions of deep vein thrombosis between differenthysterectomy surgeries under the fast track surgery management, and toobserve the incidence, the risk factors and the effective monitoring indicatorsof venous thrombosis.Methods: A total of177patients who were admitted to the department ofobstetrics and gynecology in the Second Hospital of Hebei Medical Universityfrom December2011to January2013were included in the study, and they allunderwent hysterectomy because of benign diseases. They were randomlydivided into two groups, the fast track surgery group and the traditionalsurgery group. The fast track surgery group had78patients and the traditionalsurgery group had99patients. All the patients signed the informed consentand it was agreed by the medical ethics committee. Patients with low limbvenous thrombosis and other thrombosis were removed from the research. Inthe fast track surgery group, patients and their families were told the relatedmeasures in the fast track surgery, including preoperative education, reducingmechanical enema, limiting volume of liquid, reducing the application of thedrainage tube, postoperative early feeding, early removal of urine tube andearly activities and so on. In traditional surgery group patients were managedin the conventional perioperative care way, without preoperative counseling.And other measures, like the fasting, volume of infusion, clystering twice ormore, activities and feeding were managed in traditional ways. We comparedthe times of clystering, operative time, fluid volume, the first time of exhaustand defecation time, the time of pulling out the urine tube, length of hospital stay and hospitalization costs between the fast track surgery group and thetraditional surgery group, and explored the feasibility and superiority of fasttrack surgery management after hysterectomy. Forty patients randomlyselected from the traditional surgery group and patients in fast track surgerygroup were reviewed of HGB, PLT, D-dimer, PT, APTT, Fib on the second dayand examined lower limb venous ultrasound on the forth day after the surgery.We diagnosed postoperative deep venous thrombosis according to the result oflower limb venous ultrasound. We selectively used low molecular heparin toprevent deep venous thrombosis in medium-risk and high-risk groups, whichwere divided according to DVT risk assessment of gynecological surgery infast track surgery.40patients reviewed the indicators of DVT in traditionalsurgery group were not given low molecular heparin.78patients were dividedinto the application of low molecular heparin group and the no application oflow molecular heparin group. Patients in each group were divided into theminimally invasive surgery group (laparoscopic surgery and transvaginalsurgery) and the conventional open surgery group according to differentsurgery approaches. We compared the incidence of DVT between differentminimally invasive surgery group (laparoscopic surgery and transvaginalsurgery) and the conventional open surgery group. We counted the sensitivityand specificity of the D-dimer in the diagnosis of deep venous thrombosisafter hysterectomy.Results: In all177patients,78patients were in fast track surgery group,and99patients were in traditional surgery group. There were118patientsincluding78patientes in fast track surgery and40patients reviewed theindicators of DVT in traditional surgery group, and15patients occurred DVT.The total incidence of DVT was12.71%（15/118).In fast track surgery group, there were9DVT patients, and the rate ofDVT was11.54%（9/78). senventy-eight patients in fast track surgery groupincluded11cases of low-risk group,34cases of medium-risk group,33casesof high-risk group. There were no DVT patients in low-risk group. Four DVTpatients were in medium-risk group, and the rate of DVT was11.76%(4/34). Five DVT patients were in high-risk group, and the rate of DVT was15.15%(5/33). In36patients selectively using low molecular heparin,20cases werein minimally invasive surgery. There were4DVT patients, and the rate ofDVT was20%(4/20). Low molecular heparin was used in16patients inconventional open surgery group. There were4DVT patients, and the rate ofDVT was25%（4/16). The rate of DVT in minimally invasive surgery groupwas lower than that in conventional open surgery group, but the DVTincidence had no statistical difference between two groups(20%vs.25%,P>0.05). In42patients without using low molecular heparin,21cases were inminimally invasive surgery (including2cases of low-risk group,10cases ofmedium-risk group and9cases of high-risk group). There was1DVT patient,and the rate of DVT was4.76%(1/21). Twenty-one patients in theconventional open surgery group were patients without using low molecularheparin. There was no DVT patient, and the rate of DVT was0%（0/21). Therate of DVT in minimally invasive surgery group was higher than that inconventional open surgery group, but the DVT incidence had no statisticaldifference between two groups (4.76%vs.0%，P>0.05).We monitored the DVT numbers in40patients in traditional surgerygroup. There were6DVT patients, and the rate of DVT was15%（6/40). Fortypatients in traditional surgery group included10cases of low-risk group,15cases of medium-risk group,15cases of high-risk group. One DVT patientwas in low-risk group, and the rate of DVT was10%(1/10). Four DVTpatients were in medium-risk group, and the rate of DVT was26.67%(4/15).One DVT patient was in high-risk group, and the rate of DVT was6.67%(1/15).We compared the incidence of DVT between the42patients in fasttrack surgery group without using low molecular heparin and the40patientsin traditional surgery group without using low molecular heparin, when thefactor of low molecular heparin was ruled out. There was1DVT patients in42patients in fast track surgery without using low molecular heparin, and theincidence was2.38%(1/42). The rate of DVT in fast track surgery group wassignificantly lower than that in traditional surgery (15%vs.2.38%, P<0.05). In118patients reviewed the indicators of DVT, whose value of D-dimerwas higher than or equal to0.5ug/ml were75cases, of which12casesoccurred DVT while63cases without DVT. There were43cases whose valueof D-dimer were lower than0.5ug/ml, of which DVT occurred in3cases, theother40cases didn’t. The sensitivity and specificity of D-dimer were80%and48.78%.Compared with the traditional surgery group, the group of FTS hadadvantages in the preoperative enema frequency, the time of keeping urinarycatheter, exhaust and the first postoperative defecation time, the differencewas statistically significant. There was no statistically significant difference inoperation time, intraoperative fluid intake, length of hospital stay, averagehospital costs between the two groups. Two groups of patients didn’t occurcomplications such as bleeding, infection and urinary retention duringoperation and after surgery.Conclusions: The incidence of DVT after hysterectomy in fast tracksurgery management was lower than the management of traditional operationwith statistical significance. It is safe and feasible when the fast track surgerywas managed in patients underwent hysterectomy. The measures haveadvantages in gastrointestinal recovery. Other advantages of fast track surgeryneed to be confirmed in large sample. The incidence of DVT afterhysterectomy had no statistical difference between the minimally invasivesurgery group and conventional open surgery group under fast track surgerymanagement, which may attribute to the high proportion of heparinapplication in high risk group. D-dimer has higher sensitivity and lowerspecificity when used to diagnose deep venous thrombosis after hysterectomy.Patients in medium-risk group and high-risk group have higher incidence ofDVT than low-risk group, suggesting in whom we should take preventionmeasures. |
PDF Full Text Request