Risk adapted approaches to prophylaxis of thrombotic complications at gisterectomy
DOI:
https://doi.org/10.11603/2414-4533.2018.2.9228Keywords:
endometrial cancer, thrombotic complications, hypercoagulation, thrombotic markers, D-dimer, hemostasis system, thrombosis, thrombectomy, hysterectomy.Abstract
The aim of thw work: to evaluate the condition of the hemostasis system, to develop individual approaches for the identification of risk groups and prevention of trombotic complications in patients with endometrial cancer at the preoperative stage; to optimize surgical tactics for detecting blood clots in the pelvic vessels with hy sterectomy.
Materials and Methods. The research used general-clinical methods of examination: laboratory, ultrasound, histological methods. Mathematical, statistical – for analysis and generalization of data in the package, "Statgraph" (v.3.0).
Results and Discussion. Prior to surgery, the level of D-dimer in 58.50 % of patients exceeded the norm, indicating the activation of the system of blood clotting and the threat of development of trombotic complications, which was confirmed in - 5.4 % of patients, conducted by elastrafication of small pelvic vessels. Prior to the operation, an increased level of D-dimer was observed in 86 (58.50%) patients, with an operation in 109 patients (74.15 %).
During the hysterectomy, the stump of the small pelvic vessels was inspected for the presence of thrombi. Thrombotic masses were found in 11.56 % of patients with a revision of the stump of the pelvic vessels, which were linear in size from 0.3 to 5.4 cm, which was confirmed by histological examination. In 17 patients during the thrombectomy 19 thrombi were isolated.
A mathematical model for the multiple regression equation, which can be used to predict the presence (absence) of blood clots in the veins of the pelvis, is created.
The algorithm of optimization of diagnostic and surgical tactics in patients with endometrial cancer is taken into account considering the risk of possible thrombotic complications, which allows to optimize the diagnostic and surgical tactics that promotes active detection of blood clots in patients with endometrial cancer.
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