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目的探讨子宫良性病变行经腹全子宫切除术后并发盆腔和下肢深静脉血栓形成(DVT)的治疗方法及抗凝加溶栓治疗时并发阴道残端出血的处理。方法1996年1月至2004年1月汕头大学医学院第一附属医院妇产科回顾性分析12例全子宫切除术后并发DVT的治疗方法及3例并发阴道残端出血的处理。结果12例在常规剂量的尿激酶、速避凝的溶栓治疗下,静脉复通,下肢局部水肿消退。12例溶栓治疗后3例发生阴道残端出血,2例局部止血后继续行抗凝减量溶栓治疗,未再出现阴道出血;1例局部处理有效后未行溶栓治疗,仅单纯抗凝治疗,结果DVT复发。结论DVT溶栓治疗并发阴道残端出血局部处理有效情况下,减量应用速避凝加尿激酶抗凝溶栓治疗,可取得安全、有效的溶栓效果,预防DVT复发。
Objective To investigate the treatment of pelvic and lower extremity deep venous thrombosis (DVT) after benign hysterectomy and the management of vaginal stump bleeding during anticoagulation and thrombolytic therapy. Methods From January 1996 to January 2004, the obstetrics and gynecology department of the First Affiliated Hospital of Shantou University Medical College retrospectively analyzed the treatment of 12 cases of post-hysterectomy complicated with DVT and 3 cases of vaginal stump bleed. Results Twelve patients underwent routine thrombolysis with routine dose of urokinase and thrombolytic therapy. Intravenous recanalization and local edema of the lower limbs subsided. 12 cases of vaginal bleeding after thrombolytic therapy occurred in 3 cases, 2 cases of local hemostasis continue anticoagulant thrombolytic therapy, no recurrence of vaginal bleeding; 1 case of local treatment without effective thrombolytic therapy, only simple anti- Condensation therapy, the results DVT recurrence. Conclusion DVT thrombolytic therapy complicated with vaginal stump hemorrhage local treatment is effective, the reduction rate of application of rapid avoidance coagulation plus urokinase anticoagulant thrombolytic therapy, can be safe and effective thrombolytic effect, prevention of DVT recurrence.