[Prospective investigation of postoperative lower extremity deep venous thrombosis in gynecological procedures].
OBJECTIVE
To investigate the morbidity, relevant factors and diagnostic methods of lower extremity deep venous thrombosis (LEDVT) after gynecological pelvic surgeries.


METHODS
A prospective study was carried out investigating the morbidity, characteristics, risk factors, the coagulation function changes and diagnostic methods of LEDVT post-gynecological pelvic operations in 141 cases. Platelet, prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, D-dimer, antithrombin-III, tissue plasminogen activator, plasminogen activator inhibitor were measured within 1 week before surgeries, 48 hours and 5 - 7 days post-surgeries respectively. Color Doppler flow imaging was performed simultaneously.


RESULTS
(1) Twenty-two cases were found with LEDVT, the morbidity of LEDVT after gynecological procedures was 15.6%. It occurred 2 - 7 days post operation. (2) The risk factors were bedfasting, coagulant prescription post-operation, cardiovascular disease, ageing, pelvic lymphadenectomy, general anesthesia, and malignancy. Multivariate regression showed only age and coagulant prescription post-operation were independent factors. (3) The level of D-dimer was (0.9 +/- 0.6) mg/L in LEDVT group, significantly higher than that of non-LEDVT group [(0.5 +/- 0.4) mg/L, P < 0.01]. The positive predictive value and negative predictive value of D-dimer were 30.8% and 98.6% respectively. (4) Among 22 cases who were diagnosed with LEDVT by compression duplex ultrasound, only 4 cases performed lower extremity venography, and the diagnosis was confirmed.


CONCLUSIONS
The morbidity of postoperative lower extremity deep venous thrombosis in gynecological procedures was high. The combination of D-dimer and compression duplex ultrasound examination was applicable to the diagnosis of LEDVT. The optional duration of the examination was 2 - 7 days post operations.
Liu
Yu-zhen
YZ
Department of Obstetrics and Gynecology, Affiliated of Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing, China.
Zhang
Zhen-yu
ZY
Guo
Shu-li
SL
He
Wen
W
Zhang
Xiao-rong
XR
Wang
Shu-zhen
SZ
Liu
Chong-dong
CD
Li
Jin-feng
JF
Li
Lin
L
D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008875:Middle Aged; D010048:Ovarian Cysts / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000601:surgery; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D000990:Antithrombin III