OPTIMIZATION OF THE PROPHYLAXIS OF THROMBOEMBOLIC COMPLICATIONS IN THE TREATMENT OF ACUTE CALCULAR CHOLECYSTITIS
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i4.14983Keywords:
thromboembolic complications, acute calculous cholecystitis, laparoscopic cholecystectomyAbstract
SUMMARY. Prevention of venous thromboembolism after laparoscopic operations is of great importance for maintaining the health of patients. The occurrence of such complications has become increasingly common in recent years.
The aim – to improve the results of prevention and treatment of thromboembolic complications in patients with acute calculous cholecystitis.
Material and Methods. An analysis of the diagnosis and treatment of 300 patients who underwent laparoscopic surgery for cholelithiasis at the Regional Center for Elective Surgery and Transplantology of the Rivne Regional Clinical Hospital named after Yu. Semenyuk from 2019 to 2023 was conducted. All patients were divided into two groups, group I included 162 (54 %) patients who underwent prophylaxis of venous thrombosis after laparoscopic cholecystectomy according to approved thromboprophylaxis protocols, and group II included 138 (46 %) patients who underwent prophylaxis based on the algorithm developed in the course of this study.
Results. In the course of studying the activated partial thromboplastin time (APTT) in men with acute calculous cholecystitis without concomitant pathology of the veins of the lower extremities who underwent laparoscopic cholecystectomy, it was found that the APTT decreased (p<0.05). Initially, it was (25.7±0.5) seconds before the operation and (22.0±0.4) seconds after the operation. In men with acute calculous cholecystitis and concomitant varicose veins of the lower extremities, it was found that the studied indicator, APTT, decreased (p<0.05) after laparoscopic cholecystectomy and amounted to 21 %. In patients who were distributed according to the modified model of VTE risk assessment by J. Caprini, the APTT (s) indicators after LCE were as follows: in the control group – from 26.5±0.5 (p<0.05) to 28.2±0.5 (p<0.05), and in the main group, respectively, from 26.9±0.5 (p<0.05) to 29.3±0.5 (p<0.05). In the group of patients distributed according to J. Caprini, the prothrombin time indicators increased in the postoperative period (main group) due to the use of the preventive VTE algorithm. In the group of patients distributed according to J. Caprini, prothrombin time indicators increased in the postoperative period (main group) due to the use of the preventive VTE algorithm. In the groups of patients with acute cholecystitis distributed according to J. Caprini, the activity of TBK-reactive products (μmol/l) before LHE was from 11.29±0.33 to 11.37±0.34, and after LHE were the following values: in the control group - from 6.43±0.35; p<0.05 to 7.88±0.30; p<0.05, and in the main group, respectively, from 6.28±0.31; p<0.05 to 7.35±0.34; p<0.05. Given the above data, in patients with acute cholecystitis with varicose disease, divided according to J. Caprini, the activity of TBK-reactive products (μmol/l) before LHE was from 12.23±0.30 to 12.29±0.27, and after LHE the following values were observed: in the control group – from 8.58±0.19; p<0.05; to 8.64±0.17; p<0.03, and in the main group, respectively, from 8.44±0.18; p<0.03 to 8.56±0.16; p<0.02.
The activity indicators of TBK-reactive products in patients with acute calculous cholecystitis, distributed according to J. Caprini, in the postoperative period changed more quickly to physiological indicators of the norm, compared with patients with acute calculous cholecystitis and varicose disease. Also, in patients in the main group, the indicators of TBK-reactive products were somewhat lower than in the control group, due to prophylactic pre- and postoperative correction of the blood coagulation system.
Conclusions. The process of treatment and prevention of VTE based on the J. Caprini scale makes it possible to develop and standardize algorithms for helping patients, the use of a single scale allows unifying approaches to assessing the risk of VTE in hospitals, which simplifies communication between doctors and improves quality control of medical services.
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