腹腔镜Roux-en-Y胃旁路手术中静脉血栓栓塞症的预防方法。

An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery.

作者信息

Miller M Todd, Rovito Peter F

机构信息

Department of Surgery, Lehigh Valley Hospital, Cedar Crest and I-78, Allentown, PA 18105, USA.

出版信息

Obes Surg. 2004 Jun-Jul;14(6):731-7. doi: 10.1381/0960892041590944.

DOI:10.1381/0960892041590944

PMID:15318974

Abstract

BACKGROUND

Venous thromboembolism (VTE) prophylaxis regimens for laparoscopic Roux-en-Y gastric bypass (LRYGBP) have not been adequately addressed in the literature. This study presents the results of our prophylactic regimen in LRYGBP at a tertiary care hospital.

METHODS

A retrospective review of 255 morbidly obese patients undergoing LRYGBP between March 2000 and February 2003 was conducted. Patients received preoperative subcutaneous heparin (SQH) (5000u or 7500u) and every 8 hours thereafter during hospitalization. Sequential compression devices (SCD) were utilized during and after surgery unless ambulating. Early ambulation was enforced.

RESULTS

255 patients underwent LRYGBP, with 5 (1.9%) converted to open. Average preoperative weight and body mass index (BMI) were 138 kg and 50, respectively. Operative time averaged 174 minutes. Average length of stay was 2.2 days. 9 patients (3.6%) had a prior history of deep venous thrombosis/pulmonary embolism (DVT/PE), one of whom had a DVT/PE postoperatively. 2 patients developed DVT/PE within 30 days. Overall DVT/PE incidence was 1.2%. There were 6 postoperative bleeding episodes (2.4%).

CONCLUSION

This regimen provides excellent prophylaxis against VTE in the hospital setting.

摘要

背景

腹腔镜Roux-en-Y胃旁路术（LRYGBP）的静脉血栓栓塞症（VTE）预防方案在文献中尚未得到充分探讨。本研究展示了我们在一家三级护理医院对LRYGBP患者采用的预防方案的结果。

方法

对2000年3月至2003年2月期间接受LRYGBP的255例病态肥胖患者进行回顾性研究。患者术前接受皮下肝素（SQH）（5000单位或7500单位）注射，住院期间每8小时注射一次。手术期间及术后使用序贯加压装置（SCD），除非患者在活动。鼓励早期活动。

结果

255例患者接受了LRYGBP手术，其中5例（1.9%）转为开腹手术。术前平均体重和体重指数（BMI）分别为138千克和50。平均手术时间为174分钟。平均住院时间为2.2天。9例患者（3.6%）有深静脉血栓形成/肺栓塞（DVT/PE）病史，其中1例术后发生DVT/PE。2例患者在30天内发生DVT/PE。总体DVT/PE发生率为1.2%。术后有6例出血事件（2.4%）。