Frantzides Constantine T, Welle Scott N, Ruff Timothy M, Frantzides Alexander T
Chicago Institute of Minimally Invasive Surgery, Skokie, IL 60077, USA.
JSLS. 2012 Jan-Mar;16(1):33-7. doi: 10.4293/108680812X13291597716906.
To compare the rates of venous thromboembolism (VTE) by using routine postoperative enoxaparin versus early ambulation, SCDs, hydration, and selective prophylactic pharmacologic anticoagulation.
1,692 patients undergoing laparoscopic gastric bypass from October 2001 to October 2008 were included and divided into 2 groups based on when they were operated upon. Group A (435 patients) received routine enoxaparin 12 hours after surgery. Group B (1,257 patients) received selective pharmacologic anticoagulation, in high-risk patients only.
Mean operating time was 144±26 minutes (Group A) and 126±15 minutes (Group B). Mean length of stay was 2.3±1.5 days for Group A and 1.4±1.2 for Group B. Intraluminal bleeding occurred in 21 patients (4.8%) in Group A and 5 (0.9%) in Group B; none required intervention. Five pulmonary embolisms occurred in Group A (1.1%) and none in Group B. Seven patients in Group A (1.7%) and 6 (0.47%) in Group B had clinically evident DVT. Two non-VTE related deaths occurred in Group A.
Adequate VTE prophylaxis is achieved using SCDs, early ambulation, emphasis on hydration, and shorter operating times. Bariatric surgery can be safely performed without pharmacologic VTE prophylaxis in all but the high-risk population. Fewer bleeding complications occur without the use of anticoagulants.
比较术后常规使用依诺肝素与早期活动、使用下肢循环驱动仪（SCDs）、补液及选择性预防性药物抗凝治疗静脉血栓栓塞症（VTE）的发生率。
纳入2001年10月至2008年10月期间行腹腔镜胃旁路手术的1692例患者，并根据手术时间将其分为两组。A组（435例患者）术后12小时接受常规依诺肝素治疗。B组（1257例患者）仅对高危患者进行选择性药物抗凝治疗。
A组平均手术时间为144±26分钟，B组为126±15分钟。A组平均住院时间为2.3±1.5天，B组为1.4±1.2天。A组21例患者（4.8%）发生腔内出血，B组5例患者（0.9%）发生腔内出血；均无需干预。A组发生5例肺栓塞（1.1%），B组无肺栓塞发生。A组7例患者（1.7%）发生临床明显的深静脉血栓形成（DVT），B组6例患者（0.47%）发生临床明显的DVT。A组发生2例与VTE无关的死亡。
通过使用SCDs、早期活动、强调补液及缩短手术时间可实现充分的VTE预防。除高危人群外，减重手术可不使用药物进行VTE预防而安全实施。不使用抗凝剂时出血并发症较少。
