围手术期持续服用抗凝药物对胆囊微创手术出血的影响

Effect of perioperative continuous use of Aspirin on bleeding in minimally-invasive surgery of gallbladder

摘要:

目的  探讨围手术期持续服用阿司匹林对腹腔镜下胆囊切除术（LC）出血的影响。方法  选取2013年1月-2015年5月在该院行LC的132例胆囊疾病患者为研究对象，均长期口服阿司匹林，随机分为观察组和对照组，对照组术前7 d及术后3 d停用阿司匹林，观察组患者围手术期持续服用阿司匹林，比较两组患者的术中出血量、手术时间、中转开腹率、术后出血率、输血率、血栓发生率、术后引流量、总住院时间及总住院费用。结果  两组的术中出血量、手术时间、中转开腹率、术后引流量、总住院时间及费用比较，差异无统计学意义（P >0.05），两组患者无一例出现术后出血、贫血、输血、再手术、血栓并发症等。结论  对于长期口服阿司匹林（75～100 mg/d）的择期行LC患者而言，围手术期持续服用阿司匹林不会增加术中和术后出血的发生风险，不会影响手术时间及住院时间。

Abstract:

Objective To investigate the effect of perioperative continuous use of Aspirin on bleeding in laparoscopic cholecystectomy (LC). Methods Totally 132 patients who underwent LC from January 2013 to May 2015 in our hospital and had long-term use of Aspirin were enrolled into the study. They were randomly divided into observation group and control group. The patients in the control group stopped use of Aspirin 7 days before operation and 3 days after operation while the cases in the observation group continuously used Aspirin during perioperative period. The intraoperative bleeding, operation time, rate of conversion to laparotomy, postoperative bleeding rate, postoperative blood transfusion rate, rate of major thromboembolic events, postoperative drainage volume, total hospital stay and hospital expenses were compared between the two groups. Results There was no significant difference in the intraoperative bleeding, operation time, rate of conversion to laparotomy, postoperative drainage volume, total hospital stay or hospital expenses between the two groups (P > 0.05). None of the patient had postoperative bleeding, blood transfusion or major thromboembolic events. Conclusions For patients undergoing elective LC who have long-term use of Aspirin (75-100 mg/d), perioperative continuous use of Aspirin does not increase the risk of intraoperative or postoperative bleeding, and would not affect the operation time or hospital stay either.