Novosti
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Year 2012 Vol. 20 No 4
GENERAL AND SPECIAL SURGERY
S.N. VORONOV, D.A. MILLER, A.A. GOLUBEV
PROPHYLAXIS OF VENOUS THROMBOEMBOLISM AT SURGICAL TREATMENT OF PATIENTS WITH CHRONIC CALCULOUS CHOLECYSTITIS
State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”, Ministry of Health and Social Development of Russia
The Russian Federation
Objectives. To work out the algorithm of prophylactic anticoagulant dose choice to prevent the venous thromboembolism (VTE) in patients with chronic calculous cholecystitis at surgical treatment.
Methods. On the basis of the hemostasis system studying, 58 patients of the main group were divided into 3 subgroups. In the first subgroup of patients (16 patients with hyperaggregation and hypercoagulation) were administered the standard prophylactic dose of fragmin 0,2 ml (5000 ME). In the second subgroup of patients (19 patients with hyporaggregation and hyporcoagulation) a half of the standard prophylactic dose of fragmin 0,1 ml (2500 ME) was administered. In the third subgroup of patients (23 patients with hyperaggregation and hyporaggregation of hypercoagulation of thrombocytes and hypercoagulation and hyporcoagulation) the dose of the low molecular weight heparin was administered without taking into consideration the performed analysis of the hemostasis system and all the patients got the standard prophylactic dose of fragmin 0,2 ml (5000 ME). The nearest results of the laparoscopic cholecystectomy in patients of the main group were compared with the results of the surgical treatment in 5468 patients of the control group.
Results. Reduction of the thrombocytes aggregation was registered in the patients of the first and second subgroups. In patients of the third subgroup with hyporaggregation of thrombocytes, significant depression of the blood platelet hypofunction was registered. Coagulation hemostasis changes were seen in the first and second subgroups, which were approximating to the readings of healthy subjects. At the same time the readings of the intravascular blood coagulation of SFMC was higher in the patients of the 3 group and the degree of hyporcoagulation was more marked in them. In more than half patients postoperative period was without complications. 2 cases of the intraoperative bleeding from the gallbladder bed were registered in patients of the 3rd group. Hematomas of the postoperative wounds were also revealed in these patients. None of the patients of three subgroups was noticed to develop VTE.
Conclusions. Administration of the low molecular weight heparin to prevent VTE after laparoscopic cholecystectomy in patients with hemostasis hypofunction should be half-dosed and with hyperfunction – a full standard dosed.
1. Borisov AE, red. Rukovodstvo po khirurgii pecheni i zhelchevyvodiashchikh putei [A guideline for liver and biliary tract surgery]: In 2 vol. Saint-Petersburg, RF: Skifiia, 2003. 560p.
2. Shalimov AA, Kopchak VM, Dronov AI. Kholetsistektomiia mini laparotomnym dostupom : Retrospektivnyi analiz10-letnei raboty [Cholecystectomy by minilaparotomy access: Retrospective analysis of the 10-year work]. Klin Khirurgiia. 2001;(5):12–15.
3. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc. 2012 May;26(5):1205–13.
4. Emel'ianov SI, Matveev NL, Fedenko VV. Laparoskopicheskaia khirurgiia: proshloe i nastoiashchee [Laparoscopic surgery: The past and present]. Лапароскопическая хирургия: прошлое и настоящее. Endoskop Khirurgiia. 1995;(1):5–7.
5. Golubev AA, Eremeev AG, Voronov SN, Teben'kov MN, Kulakov PA. Tromboembolicheskie oslozhneniia pri lechenii zhelchekamennoi bolezni [Thromboembolic complications in the treatment of cholelithiasis]. Endoskop Khirurgiia. 2006;12(2):33–4.
6. Golubev AA, Eremeev AG, Volkov SV, Kononova AG, Kuakov PA, Baigazakov AT. Vliianie napriazhennogo karboksiperitoneuma na gazovyi sostav i kislotno-shchelochnoe sostoianie krovi patsientov pri vypolnenii laparoskopicheskoi kholetsistektomii [Effect of stressful carboxyperitonium to gas composition and acid-base status of blood of patients with laparoscopic cholecystectomy]. Tsentral'no Aziatskii Med Zhurnal. 2010;16 (3):24–26.
7. Catheline JM. Gaillard JL, Rizk N, Barrat C, Champault G. Risk factors and prevention of thromboembolic risk in laparoscopy. Ann Chir. 1998;52(9):890–95. [Article in French]
8. Kanwer DB, Kaman L, Nedounsejiane M, Medhi B, Verma GR, Bala I. Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy–a randomised controlled trial. Trop Gastroenterol. 2009 Jul-Sep;30(3):171–74.
9. Bokarev IN, Popova LV, Kozlova TV. Trombozy i protivotromboticheskaia terapiia v klinicheskoi praktike [Thrombosis and antithrombotic therapy in clinical practice]. Мoscow, RF: Medinform agenstvo; 2009. 512 p.
10 Gould MK. Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in Nonorthopedic Surgical Patients. Chest. 2012;141(2 Suppl):e227S–e277S.
11. Savel'ev VS, Chazov EI, Gusev EI, Kirienko AI. Rossiiskie klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike venoznykh tromboembolicheskikh oslozhnenii [Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolism]. Phlebology. 2010;4(1 Vyp. 2):1–38.
12. Ob utverzhdenii otraslevogo standarta "Protokol vedeniia bol'nykh. Profilaktika tromboembolii legochnoi arterii pri khirurgicheskikh i inykh invazivnykh vmeshatel'stvakh"[On approval of industry standard Protocol of patient treatment. Prevention of pulmonary embolism in surgical and other invasive intervention] (OST 91500.11.0007-2003): Prikaz M-va zdravookhraneniia Ros Federatsii; № 223 ot 9 iiunia 2003.
13. Voronov SN, Miller DA, Golubev AA, Eremeev AG, Kononova AG. Izuchenie trombotsitarnogo gemostaza u bol'nykh khronicheskim kal'kuleznym kholetsistitom dlia otsenki stepeni riska tromboembolicheskikh oslozhnenii posle laparoskopicheskoi kholetsistektomii [The study of platelet hemostasis in patients with chronic calculous cholecystitis to evaluate the risk of thromboembolic complications after laparoscopic cholecystectomy]. Endoskop khirurgiia. 2009;(4):22–27.
14 .Baluda VP, Sokolov EI, Baluda MV, Makarov VA. «Manzhetochnaia» proba v diagnostike funktsional'nogo sostoianiia sosudistogo zvena sistemy gemostaza ["Cuff" test in the diagnosis of the functional vascular state of hemostasis] Gematologiia i Transfuziologiia. 1987;(9):51–53.
15. Aronov DM. Funktsional'nye proby v kardiologii [Functional tests in cardiology]. Moskow, RF: Medpress-inform; 2007. 328 p.
16. Kamyshnikov VS. Gemostaziologiia v klinicheskoi i laboratornoi praktike [Hemostasiology in clinical and laboratory practice]. Minsk, RB: Adukatsyia i vykhavanne; 2011. 320 p.
170000, Rossiyskaya FederatsiyaTver, ul. Sovetskaya, d. 4, GBOU VPO «Tverskaya gosudarstvennaya meditsinskaya akademiya», kafedra gospitalnoy hirurgii s kursom urologii,
e-mail: voronov-sergej@mail.ru,
Voronov Sergey Nikolaevich
Voronov S.N., Candidate of Medical Sciences, Assistant of the Hospital Surgery Chair with the Course Of Urology of State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”
Miller D.A., Doctor of Medical Sciences, Professor of the Faculty Therapy Chair of State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”
Golubev A.A., Candidate of Medical Sciences, Associate Professor of the Hospital Surgery Chair with the Course of Urology of State Budgetary Educational Establishment of Higher Professional Education “Tver State Medical Academy”.
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