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目的探讨妇科腹腔镜手术后下肢深静脉血栓形成(DVT)的危险因素。方法回顾性分析2013年2月-2015年2月宁波市北仑区人民医院339例行妇科腹腔镜手术患者的临床资料,对患者的一般临床资料、术前实验室检查指标、手术类型、术中治疗及术后干预措施等进行单因素及多因素logistic回归分析。结果 339例行妇科腹腔镜手术患者中30例术后发生DVT,发生率为8.85%,经单因素和多因素logistic回归分析最终筛选出:年龄(OR=1.438)、手术类型(腹腔镜妇科恶性肿瘤手术)(OR=3.153),血浆D-二聚体水平≥0.5 mg/L(OR=2.531)、术前合并症(OR=2.885)、术中气腹压(OR=2.835)、手术时间≥1 h(OR=1.397)、术后卧床天数(OR=1.498)与妇科腹腔镜手术后发生DVT密切相关(P<0.05)。结论年龄超过50岁、手术类型(腹腔镜妇科恶性肿瘤手术)、血浆D-二聚体水平≥0.5 mg/L、术前有合并症、术中气腹压>15 mm Hg、手术时间≥1 h及术后卧床天数>5 d是妇科腹腔镜术后发生DVT的独立危险因素,应针对性对此类高危因素进行干预,以期降低术后DVT的发生率。
Objective To investigate the risk factors of lower extremity deep venous thrombosis (DVT) after gynecological laparoscopic surgery. Methods The clinical data of 339 gynecological laparoscopic patients in Beilun District People’s Hospital of Ningbo from February 2013 to February 2015 were retrospectively analyzed. The clinical data, preoperative laboratory indexes, types of surgery, Treatment and postoperative intervention measures such as univariate and multivariate logistic regression analysis. Results Thirty cases of DVT occurred in 339 patients undergoing gynecological laparoscopic surgery. The incidence of DVT was 8.85%. The results of univariate and multivariate logistic regression analysis showed that age (OR = 1.438), type of surgery (laparoscopic gynecological malignancy (OR = 3.153), plasma D-dimer level≥0.5 mg / L (OR = 2.531), preoperative complications (OR = 2.885), intraoperative pneumoperitoneum pressure (OR = 2.835), operation time ≥1 h (OR = 1.397), days after bed rest (OR = 1.498) were significantly correlated with DVT after gynecological laparoscopic surgery (P <0.05). Conclusions The age of patients over 50 years old, the type of surgery (laparoscopic gynecologic malignancy surgery), plasma D-dimer level ≥ 0.5 mg / L, preoperative complications, intraoperative pneumoperitoneum pressure> 15 mm Hg, operation time ≥ 1 h and postoperative bed days> 5 d are independent risk factors for DVT after gynecological laparoscopic surgery. Such high risk factors should be targeted to reduce the incidence of postoperative DVT.