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目的:观察腹腔镜手术对患者血液凝固性的影响及其与患者血浆α颗粒膜蛋白(plasma alpha-granule membrane protein140,GMP-140)、D-二聚体及血管性血友病因子(von Willebrand factor,VWF)表达水平的关系。方法:选取湘西自治州人民医院治疗的无血栓形成危险因素的ASA I～II级妇科患者75例,其中39例行腹腔镜手术治疗,36例行开腹手术治疗。分别在手术前、手术结束即刻、手术结束后24h采集血液标本,检测血浆凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fi-brinogen,FIB)、凝血酶时间(thrombin time,TT)。患者在采用酶联免疫吸附法定量测定血浆标本中GMP-140,D-二聚体,VWF表达水平。结果:腹腔镜组,与手术前比较,手术结束即刻PT明显延长(P<0.05),术后24h,患者PT延长,FIB明显升高,TT时间明显缩短(P<0.05)。两组患者GMP-140,D-二聚体,VWF表达水平在手术结束后即刻以及术后24h明显高于术前(P<0.05);其中腹腔镜组3种检测因子的表达水平均明显高于同期的开腹组(P<0.05)。结论:腹腔镜手术可导致患者血液凝固性增加,且此状态的产生与GMP-140,D-二聚体及VWF表达水平增加有密切关系。
OBJECTIVE: To observe the effect of laparoscopic surgery on blood coagulation and its relationship with plasma alpha-granule membrane protein 140 (GMP-140), D-dimer and von Willebrand factor, VWF) expression levels. Methods: Seventy - five ASA class I ~ II gynecological patients were selected for treatment of thrombosis risk factors in People ’s Hospital of Xiangxi Autonomous Prefecture. Among them, 39 were treated by laparoscopy and 36 by laparotomy. Blood samples were collected 24h before operation, immediately after operation and 24h after operation, respectively. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen -brinogen, FIB), thrombin time (TT). Patients in the use of enzyme-linked immunosorbent assay quantitative determination of plasma samples GMP-140, D-dimer, VWF expression levels. Results: In the laparoscopic group, PT was significantly prolonged immediately after the operation (P <0.05). After the operation, PT was prolonged, FIB was significantly increased and TT was significantly shorter in the laparoscopic group (P <0.05). The expression levels of GMP-140, D-dimer and VWF in both groups were significantly higher than those before operation and 24h after operation (P <0.05), and the expression levels of three detection factors in laparoscopic group were significantly higher In the same period of open group (P <0.05). Conclusion: Laparoscopic surgery can lead to an increase in blood coagulation, and this state is closely related to the increased expression of GMP-140, D-dimer and VWF.