Zacharoulis Dimitris, Kakkar Ajay K
Department of Surgical Oncology and Technology, Faculty of Medicine, Imperial College of Science, Technology & Medicine, London, UK.
Curr Opin Pulm Med. 2003 Sep;9(5):356-61. doi: 10.1097/00063198-200309000-00003.
Currently there are limited randomized data regarding thromboprophylaxis in laparoscopic surgery. The aim of this article is to identify principles to guide safe practice with regard to prevention of venous thromboembolism. With the exception of laparoscopic cholecystectomy, there are no prospective, randomized studies comparing the incidence of venous thromboembolism between a conventional procedure and a laparoscopic procedure for the same operation. Surveys of surgical practice indicate that policies for venous thromboembolism prophylaxis in laparoscopic surgery are generally the same as those for conventional surgery. The increasing use of a minimal access approach for a variety of abdominal, pelvic, and thoracic procedures demands further prospective, randomized studies in this area. Current guidelines endorsed by The Society of American Gastrointestinal Endoscopic Surgeons recommend following the adoption of protocols used in conventional surgery for the equivalent laparoscopic operation, and the European Association for Endoscopic Surgery has recommended the use of intraoperative intermittent pneumatic compression of the lower extremities for all prolonged laparoscopic procedures. There is only limited evidence to support these recommendations. Venous thromboembolism is an important and preventable complication in surgical patients. Evidence does not exist to consider laparoscopic surgery patients to be at a substantially lower risk for venous thromboembolism than those undergoing conventional procedures. Currently there is a lack of data regarding the prophylaxis against venous thromboembolism in laparoscopic surgery, and the practice is thus opinion based. The authors recommend that the use of standard prophylactic regimens tailored to specific patient populations for conventional operations be adopted for laparoscopic surgery until prospective data are available.
目前，关于腹腔镜手术中血栓预防的随机数据有限。本文旨在确定指导预防静脉血栓栓塞安全实践的原则。除腹腔镜胆囊切除术外，尚无前瞻性、随机研究比较同一手术的传统手术与腹腔镜手术之间静脉血栓栓塞的发生率。外科手术实践调查表明，腹腔镜手术中静脉血栓栓塞预防策略通常与传统手术相同。各种腹部、盆腔和胸部手术中越来越多地采用微创入路，这需要在该领域进行进一步的前瞻性、随机研究。美国胃肠内镜外科医师协会认可的现行指南建议，对于等效的腹腔镜手术，采用传统手术中使用的方案，欧洲内镜外科学会建议对所有长时间的腹腔镜手术使用术中下肢间歇性气动压迫。支持这些建议的证据有限。静脉血栓栓塞是外科手术患者中一种重要且可预防的并发症。没有证据表明腹腔镜手术患者发生静脉血栓栓塞的风险比接受传统手术的患者低很多。目前缺乏关于腹腔镜手术中预防静脉血栓栓塞的数据，因此这种做法基于观点。作者建议，在获得前瞻性数据之前，腹腔镜手术应采用针对传统手术特定患者群体的标准预防方案。
