Incidence of clinically evident deep venous thrombosis after Laroscopic Roux-en-Y Gastric bypass
Incidence of clinically evident deep venous thrombosis after Laroscopic Roux-en-Y Gastric bypass
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腹腔镜 Roux-en-Y 胃绕道术后临床明显深静脉血栓的发生率
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发表时间：
2004
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通讯作者：
R. Clements
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作者：
Q. González;D. Tishler;J. Plata;Anthony Bondora;S. Vickers;T. Leath;R. Clements
研究背景高龄、大整形外科手术、肿瘤性疾病、手术时间延长、静脉曲张、制动、含雌激素药物和肥胖是术后血栓栓塞并发症发生的已知危险因素。围手术期肝素可用于降低深静脉血栓形成（DVT）的发生率，但它与离散出血率相关。本研究的目的是确定临床上明显的DVT的发病率在病态肥胖的患者腹腔镜Roux-en-Y胃旁路手术后，气动压缩软管被用来作为唯一的预防DVT而不是anticoagulants.MethodsFrom 2000年4月至2003年4月，380例患者进行了腹腔镜Roux-en-Y胃旁路手术病态肥胖的一个外科医生（RHC）。在术后期间，对每位患者进行了DVT的临床评估。在手术开始前放置小腿长度的充气加压袜，并保持在原位，直到患者能够走动。手术当晚，阿姆斯壮受到了鼓舞。结果380例患者中，女性346例，男性34例，年龄14-65岁，平均39.3 ± 9.4岁。这些患者的平均体重为299.5 ± 53.6 lb（范围：188-483 lb），平均体重指数为48.5 ± 6.6（范围：36-70）。平均手术时间103。3 ± 24.3 min（范围：62-227 min），平均美国麻醉学会（阿萨）评分为2.6。9例患者术前有严重慢性静脉疾病的临床证据。1例患者（0.26%）在多普勒超声检查中发生了临床上明显的DVT，仅限于腘静脉。皮下注射分级肝素2周后，随访多普勒超声检查证实血凝块完全消退。没有临床上明显的肺血栓栓塞发生在本studygroup.ConclusionsThe临床上明显的DVT腹腔镜Roux-en-Y胃旁路手术后的发病率是低的，当该程序完成了一个相对较短的手术时间，与小腿长度的气动压缩软管诱导麻醉前，并与常规早期american。当满足这些条件时，不强制使用任何形式的肝素抗凝。
BackgroundAdvanced age, major orthopedic surgery, neoplastic disease, prolonged operations, varicose veins, immobilization, estrogen-containing medications, and obesity are known risk factors for the development of postoperative thromboembolic complications. Perioperative heparin is useful for reducing the incidence of deep venous thrombosis (DVT), but it is associated with a discrete bleeding rate. The purpose of this study was to determine the incidence of clinically evident DVT in morbidly obese patients after laparoscopic Roux-en-Y gastric bypass when a pneumatic compression hose is used as the only prophylaxis against DVT instead of anticoagulants.MethodsFrom April 2000 to April 2003, 380 patients underwent laparoscopic Roux-en-Y gastric bypass for morbid obesity by one surgeon (R.H.C.). Prospectively, each patient was clinically evaluated for the presence of DVT during the postoperative period. Calf-length pneumatic compression stockings were placed before the procedure began, and remained in place until the patient was ambulatory. Ambulation was encouraged on the evening of the operation. No pharmacologic anticoagulant was used as a prophylaxis against DVT.ResultsOf the 380 patients, 346 were women and 34 were men with a mean age of 39.3 ± 9.4 years (range, 14–65 years). The mean weight of these patients was 299.5 ± 53.6 lb (range, 188–483 lb), and their mean body mass index was 48.5 ± 6.6 (range, 36–70). The mean operative time was 103. 3 ± 24.3 min (range, 62–227 min), and mean American Society of Anesthesiology (ASA) score was 2.6. Nine patients had clinical evidence of severe, chronic venous disease preoperatively. One patient (0.26%) experienced a clinically evident DVT limited to the popliteal vein on duplex ultrasonography. The clot resolved completely, as evidenced by follow-up duplex ultrasonography after 2 weeks of subcutaneously injected fractionated heparin. No clinically evident pulmonary thromboembolism occurred in this study group.ConclusionsThe incidence of clinically evident DVT after laparoscopic Roux-en-Y gastric bypass is low when the procedure is accomplished with a relatively short operative time, with the initiation of calf-length pneumatic compression hose before the induction of anesthesia, and with routine early ambulation. No form of heparin anticoagulation is mandatory when these conditions can be met.