| Object:To compare the incidence of lower extremity deep vein thrombosis after radical resection of rectal cancer by laparoscopy and laparotomy,and evaluate the effect of two surgical methods on DVT.Methods:76 Patients with diagnosis of advanced rectal cancer admitted to the Dept of General Surgery of The First Affiliated Hospital of Hebei Northern University from June 2018 to June 2019 according to the inclusion criteria were selected and individed into the laparoscopic surgery group（LS,40 cases）and the open surgery group（OS,36 cases）.Surgical treatment was performed by the same team of physicians,and preoperative general information,intraoperative indicators（operative time,intraoperative blood loss and infusion volume）and postoperative related indicators（anal exhaust time,activity time,hospital stay,lung infection,urinary tract infection,incision infection and anastomotic fistula）were observed and compared.Changes of Arterial partial pressure of carbon dioxide（Pa CO2）and Hydrogen ion concentration（p H）were observed and compared between the two groups 5 minutes before surgery,30 minutes after surgery and 10 minutes after abdominal closure.To observe and compare the coagulation function of the two groups of patients 1 day before surgery and at different time points after surgery.Thromboelasmogram（TEG）of the two groups of patients was detected,the number and incidence of DVT in the lower extremity of the two groups were calculated.Risk factors of DVT after rectal cancer surgery were analyzed,and ROC curve was used to evaluate the efficacy and threshold of TEG in diagnosing DVT.Results:There was no significant difference in gender,age,body mass index and tumor stage between the two groups（P>0.05）.In the comparison of Pa CO2and p H values,there was a statistical difference between the T2time node and T1 time node in the LS group and the T2 time node in the OS group（P<0.05）.The incidence of total DVT in the LS group（37.5%）was higher than that in the OS group（13.9%）,with a statistical difference（P<0.05）.There was no statistical difference between the LS group with symptomatic DVT（12.5%）and OS group with symptomatic DVT（8.3%）（P>0.05）,and there was a statistical difference between the LS group with asymptomatic DVT（25%）and OS group with asymptomatic DVT（5.6%）（P<0.05）.The LS group was shorter than the OS group in terms of postoperative exhaust time,postoperative activity time and hospital stay.For PT and APTT,there was a statistically significant difference between the postoperative day 1 and the preoperative day in the LS group,and difference between the two groups on the postoperative day 1（P<0.05）,but TT showed no significant change（P>0.05）,In the LS group,D-D on the1st,3rd,5th and 7th day after surgery was higher than that before surgery,with statistical difference（P<0.05）.Statistical results of risk factors and OR values showed:age（4.00）,ASA grade（3.48）,smoking history（3.67）,tumor stage（3.34）,surgical method（3.72）and hypertension（3.00）were important risk factors for DVT after radical resection of rectal cancer.Thromboelastography shows:for R value and K value,there was no significant difference between the two groups or between the same group before and after surgery（P>0.05）,forαangle and MA value,the postoperative days 1,3,5 and 7 of the two groups were all higher than the preoperative days,with statistical difference（P<0.05）,there was a statistical difference between LS group and OS group at the same postoperative time point（P<0.05）,theαangle and MA value of postoperative ROC curve shows:the area under the curve（AUC）is 0.843and 0.791,the critical values were 63.35 and 64.95.Conclusion:The incidence of lower limb deep vein thrombosis after laparoscopic radical resection of rectal cancer is higher than that of traditional open radical resection of rectal cancer;There was no significant difference in the incidence of symptomatic lower extremity deep vein thrombosis between the laparoscopic radical resection of rectal cancer and the open radical resection of rectal cancer,while the incidence of asymptomatic lower extremity deep vein thrombosis was higher in the laparoscopic surgery group than in the open surgery group;Thromboelastography had a moderate predictive effect on the occurrence of deep venous thrombosis in lower extremities within 7 days after radical resection of rectal cancer. |
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