The impacts of laparoscopic surgery and laparotomy on the incidence of lower extremity deep venous thrombosis in patients with primary hepatocellular carcinoma after operation

Objective To observe the impacts of laparoscopic surgery and laparotomy on the incidence of lower extremity deep venous thrombosis (DVT) in patients with primary hepatocellular carcinoma (HCC) after operation, and to explore the predictive effect of thrombelastogram (TEG) and coagulation parameters on the occurrence of DVT after operation. Methods From August 2016 to June 2019, 120 patients with HCC in our hospital were selected and they were divided into laparoscopic operation group and laparotomy group by the random number table method, with 60 cases in each group. The changes of thrombelastogram (TEG) parameters (such as: R value, K value, alpha angle, and MA value) and coagulation function parameters [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin coagulation time (TT), D-dimer (D-D)] were compared before and after operation. The incidence of DVT within 7 days after operation in the two groups was counted, and the differences of the hospitalization time and the total incidence of complications between the two groups were analyzed. Results There were no statistically significant differences in TT, R, and K values between the two groups before and after surgery (P>0.05). Compared with the same group before operation, the DD, alpha angle, and MA values in each group were higher at 1, 3, and 7 days after operation, and the DD, alpha angle, and MA values in the laparoscopic operation group were higher at 1, 3, and 7 days after operation than those in the laparotomy group at the same time points (P 0.05), but the hospitalization time of the laparoscopic operation group was significantly lower (P<0.01). The postoperative patients were regrouped according to whether DVT occurred. Compared with the DVT group, the α value, MA value, and DD were significantly lower in the non-DVT group at 1 day after operation (P<0.05). The receiver operating characteristic curve analysis showed that only the area under curve of alpha angle was greater than 0.7. Conclusion There is no statistically significant difference in the incidence of DVT in lower extremities between patients with HCC receiving two surgical methods. The alpha angle of TEG has a moderate predictive effect on the occurrence of DVT in patients with HCC within 7 days after operation. Key words: Laparoscopic surgery; Primary hepatocellular carcinoma; Deep venous thrombosis; Thrombelastogram; Receiver operating characteristic curve