INFLUENCE OF INTRACAVITY HYPERTENSION ON D-DIMER LEVEL DURING ENDOSURGICAL OPERATIONS IN THE RETROPERITONEAL SPACE

Lobanov Yuri S., Shapovalov Konstantin G., Lobanov Sergey L., Tereshkov Pavel Petrovich, Lobanov Leonid Sergeevich

Purpose of the work: to evaluate the dynamics of the thrombosis marker D-dimer depending on the degree of intracavitary pressure during operations in the retroperitoneal space using laparoscopic and retroperitoneal access. Material and methods: a prospective study was conducted in 85 patients operated on for kidney cysts. In 41 cases (RPG group), the operation was performed from a retroperitoneal approach with the imposition of retropneumoperitoneum, 44 patients (PP group) were operated on from a laparoscopic approach with the creation of pneumoperitoneum. In each of these groups, two comparable subgroups are distinguished, differing in the degree of gas pressure (8 - 12 mm Hg and 12-16 mm Hg) in the abdominal cavity or retroperitoneal space. D-dimer in the blood was determined before surgery, as well as on the 1st and 3rd days after surgery. The diameter of the lower extremities was also measured before surgery, as well as on days 3 and 5 after surgery. Results and discussion. It was found that on the first day after surgery, arterial hypertension was above 12 mmHg. There is an increase in the level of D-dimer by 5 - 5.5 times compared to the initial level both with laparoscopic and retroperitoneal methods. After three days, this indicator decreased in all groups to the initial values. When the mode is below 12 mm Hg. No significant fluctuations in D-dimer levels were detected. For hypertension above 12 mm Hg. Art. after surgery, edema of the lower extremities was observed in 16 patients (18.8%), and at a rate of up to 12 mm Hg. Art. in 4 (4.7%). Conclusion. The data obtained indicate a change in blood circulation in conditions of intracavitary hypertension due to compression of the veins of the abdominal cavity and retroperitoneal space with changes in microcirculation. In this case, we can assume changes in the hemostatic system, the reaction to which is an established increase in the level of de-dimer on the 1st day after surgery.

Keywords:D-dimer, thrombosis, retropneumoperitoneum, pneumoperitoneum.