Выбор метода профилактики тромботических осложнений у пациентов с хирургическими заболеваниями желудка высокого риска

Abstract

INTRODUCTION: Despite the significant advances in the prevention and treatment of venous thromboembolic complications (VTEC), pulmonary embolism (PE) remains the most common preventable cause of hospital postoperative mortality. One of the causes of thrombosis is surgical operations, especially laparoscopic, associated with the activation of the hemostasis system. Aim: The choice of a prevention method of thrombotic complications in comorbid patients with signs of varicose veins of the lower extremities requiring laparoscopic surgical treatment of benign gastric diseases (BGD). MATERIALS AND METHODS: The study is based on a treatment analysis of 128 patients with BGD in combination with a high comorbid background. The treatment of these patients was divided into several stages, which included both vascular interventions for the prevention of VTEC and a laparoscopic stage aimed at treating the underlying disease. The patients were divided into 3 groups comparable in gender and age. The first group, consisting of 45 people, VTEC prevention was carried out using a standard conservative technique (anticoagulant therapy in combination with mechanical prophylaxis). The second group included 43 patients who underwent both standard conservative therapy and open surgery aimed at correcting venous insufficiency in the great saphenous vein system. The third group is represented by 40 patients who, in addition to the standard conservative prevention of VTEC, underwent a combined surgical treatment (crossectomy and endovenous laser coagulation (EVLC) of the trunk of the great saphenous vein by retrograde method). All patients underwent coagulogram analysis and ultrasound triplex scanning of the veins of the lower extremities at each stage of the treatment. RESULTS: In the first group of patients, the largest number of thrombotic complications was noted — 24.4%, in the second group their number was 14%, while in the third group, thrombotic complications were detected in only 7.5% of patients. In the second and third groups, there was no development of PE, both after the first operation and after the main laparoscopic stage of treatment. In the first group, on the contrary, 2 episodes of PE (4.4%) were noted after the main surgical treatment. In turn, the standard anticoagulant therapy carried out in all three groups led to the development of both small and large hemorrhagic complications. At the same time, it should be noted that their frequency was comparable in all three groups, and their number did not exceed the number of such complications based on literature data. CONCLUSION: Carrying out active operative prevention of thrombotic complications significantly reduces their frequency in comorbid patients with signs of varicose veins of the lower extremities, thereby allowing to improve the result of the treatment. Considering that laparoscopic surgical interventions on the stomach increase the risk of developing VTEC in comorbid patients, according to our data, performing EVLC in combination with crossectomy, as the first stage of prophylaxis, prevents the development of PE and reduces the risk of venous thrombotic complications by 16.9%.