Инцидентность венозных тромбозов в европейской популяции: роль хирургических вмешательств

Abstract

У статті розглядається інцидентність венозних тромбоемболічних ускладнень та роль хірургічних втручань у розвитку венозних тромбозів. За даними проведеного огляду встановлено, що більш ніж 70% тромбозів глибоких вен нижніх кінцівок, які виникають після хірургічних втручань перебігають безсимптомно, при цьому досить часто фатальна тромбоемболія легеневої артерії є першим та єдиним проявом венозного тромбозу, займаючи третє місце у загальній структурі причин раптової смерті. Венозні тромбоемболічні ускладнення супроводжуються поверхневим тромбофлебітом у 25% хворих, при цьому в більшості випадків діагностується тромбоз глибоких вен, а в 3,9% випадків виникає тромбоемболія легеневої артерії. Серед чинників хірургічного ризику венозних тромбоемболій відмічений зв’язок із загальною анестезією, тривалістю оперативного втручання більше 2-х годин, тромбоцитозом, хронічною серцевою недостатністю, наявністю асциту, гіпоальбумінемією; В статье рассматривается инцидентность венозных тромбоэмболических осложнений и роль хирургических вмешательств в развитии венозных тромбозов. По данным проведенного обзора установлено, что свыше 70,0% тромбозов глубоких вен нижних конечностей после общехирургических операций протекают бессимптомно, при этом фатальная тромбоэмболия легочной артерии часто является первым и единственным проявлением венозного тромбоза, занимая третье место в общей структуре причин внезапной смерти. Венозные тромбоэмболические осложнения сопровождаются поверхностным тромбофлебитом у 25,0% больных, при этом в большинстве случаев диагностируется тромбоз глубоких вен, а в 3,9% случаев возникает тромбоэмболия легочной артерии. Среди факторов хирургического риска венозных тромбоэмболий отмечена связь с общей анестезией, длительностью операции более 2 часов, тромбоцитозом, наличием асцита, хронической сердечной недостаточности, гипоальбуминемией; The article discusses the incidence and role of surgical interventions in the development of venous thrombosis. Venous thrombosis is acute disease, which characterized by the formation of a blood clot in the lumen of the veins with the expressed or unexpressed inflammatory process and in the basis of blood flow disorders. If there is inflammation of the walls of veins or (and) the surrounding tissues in the area of thrombosis contributes another name of this disease is Thrombophlebitis (TF). Thromboembolic diseases remain one of the major causes of death and disability in industrialized countries. Venous thrombosis has prescribed as the disorder with multifactorial nature: among with acquired risk factors, an important role in its development plays a genetic predisposition. Aim of the investigation: to analyze the available data on incidence study of venous thromboembolism in abdominal surgery, as well as clinical peculiarities of this pathology among the people with surgical interventions. It was set by analyzing of different data that the incidence of venous thromboembolism associated directly with expeditious surgical abdominal and non-abdominal interventions is also very diverse. It was found that the mortality rate, which deal with any complications, including postsurgical deep vein thrombosis and pulmonary thromboembolism, depends directly on the aim and the type of surgery. Despite the presented an array of data on the incidence and risk factors of venous thrombosis, still not assessed the real mechanism and directions of the interaction of risk factors, there is no final stratification of risk primarily for deep vein thrombosis. Important are data on the seasonal trend of vein thromboembolism. The study of the prevalence, characteristics of the pathogenesis of thrombotic complications in patients in the postoperative period, improving of the complex of preventive measures of this kind of postoperative complications has important medical and social importance. Some of the researches focused on the development of vein thromboembolism depending on the selectivity of surgical intervention and the degree of their emergency state (emergent, urgent and non-urgent). Among the major abdominal operations, the risk of deep vein thrombosis is primarily associated with operations in gastroesophageal bile, pancreatic and duodenal zones. The studies also definitely indicate that the risk of developing thromboembolic complications reliably increases in postoperative period, which duration is more than 91 days after operations. Thus, it is established that the risk of venous thromboembolism increases dramatically in the early postoperative period (the first 30 days after surgery), but at the same time remains high and probably for more than 90 days after the surgical intervention. This trend also was observed in the outpatient surgery, including urologic and arthroscopic interventions. The introduction of high-tech, minimally invasive interventions did not lead to the expected reduction in the incidence of vein thromboembolic complications. When laparoscopic interventions less pronounced changes in hemostasis system compared with traditional operations. However, laparoscopic surgeries due to carboxyperitoneum noted the decrease of volume and linear blood flow velocity in the lower hollow vein of veins of lower extremities. Conclusions: according to the survey it was found that more than 70,0% of deep vein thrombosis of lower limbs after general surgical operations occur asymptomatically, while fatal pulmonary artery thromboembolism is often the first and only manifestation of venous thrombosis, occupying the third place in the overall structure of the causes of sudden death. Venous thromboembolic complications are accompanied by superficial thrombophlebitis at 25,0% of patients, with most cases diagnosed deep vein thrombosis, and 3,9% in case of pulmonary embolism occurs. Surgical risk factors of venous thromboembolism have marked links with general anesthesia, operation duration over 2 hours, thrombocytosis, the presence of ascites, chronic heart failure and the presence of hypoalbuminemia.